Head’s Up on Possible Medicare Processing SNAFU

This is purely anecdotal at this point.  I have not been able to find anything on public record that substantiates it.  However, given the current circumstances and the concerns that so many citizens presently have about our government’s payment for Medicare services, I’ve decided to share this information.

A Medicare recipient that I personally know has informed me that they received a letter today from their secondary private insurance provider informing them that claims for recent services provided by their doctor are being reviewed.  In response to this letter, the person contacted their insurance provider to find out what is going on.  Here’s what they were told…

A data system error has occurred at some point in the Medicare payment system causing traceability of 30,000 medical billing claims to be lost.  At this point, Medicare does not know which billing claims may or may not have been paid, which means that all 30,000 claims have to be reviewed.  The claims review includes records back into the year of 2009, which indicates a significant system error that hasn’t been caught prior to this time.

In other words, to all Medicare patients who read this or to someone who reads this who may have a family member that is a Medicare recipient, if they receive an explanation of benefits statement or billing statement from a provider that might be questionable, please take the time to call their secondary insurance provider first before they make payments to determine if the situation described may or may not be applicable in their case.

I know that the medical claims billing process is multi-staged.  The claims go through a clearinghouse first to be validated prior to being submitted to Medicare.  It is possible that the procedural data system methods of one of the major clearinghouses are the root of the current problem rather than anything pertaining to Medicare systems or procedures.  I do not know for certain what regulatory measures may or may not exist that require daily backup of billing data, or how easy/difficult it might be to restore that data.

Yet, this type of situation raises a lot of questions doesn’t it?  We’ve all got our share of concerns about Obamacare, the feasibility or lack thereof of the provisions included in the law, the impact that it will have on access to health care services, and how well our government is genuinely prepared to deal with the responsibilities that are involved in the process.  Instances such as this do not bode well for what lies ahead.

If the system and/or process doesn’t have the capability or capacity to deal efficiently with the demands currently being placed on it, without seeing these types of system errors occur, then why in the world should we think it will be efficient enough to have the capability or capacity that will be needed when we have roughly 30 million more people added to it?


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