What to do when Medicare says your pt is dead?
We have been seeing a medicare pt for about 3 months now. We have yet to get paid. The denial code is that the date of death preceeds the date of service. We have called many times to medicare to try to get this straightened out but according to them, she is still dead. My husband saw this pt last week. I asked him if he did a very detailed cardiac exam and was sure the pt's heart was really beating. He heard it and the pt did report that she was actually alive but not necessarily feeling so great.
Has this happened to anyone else? How to convince the feds that you are not dead when they have determined that you are? The pt has called them but I'm not so sure if they believed her either. Any advice?
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Category: General Interest
Posting ID: 38556 Posted on July 21, 2009 by DocLMG
View most recent Comments (35)
portdoc2 Family Medicine Posted Jul 21, 2009 at 4:55 PM
The newspapers usually like stories like that.
hermosasay Anesthesiology Posted Jul 21, 2009 at 5:00 PM
how about fox news
yes
yes
yes
headlines
could happen to anyone
then of course
u tube is where the news appears first
suvarov Internal Medicine Posted Jul 21, 2009 at 5:15 PM
catch-22
DocESP Radiology Posted Jul 21, 2009 at 5:20 PM
Medicare might be on to something...if they do this for a few million people, healthcare costs will really come down.
sayaah Otolaryngology Posted Jul 21, 2009 at 6:29 PM
Does the patient still get Social Security checks/deposits?
lasermed1 OBGYN Posted Jul 21, 2009 at 8:29 PM
It took 4 months to get my address changed when we moved.
Good luck.
neur0n Neurology Posted Jul 21, 2009 at 8:36 PM
One of my patients told me when her mother died, social security continued to send checks for a year. She tried to inform them of her death, but they asked for proof. She presented the death certificate and was told that was not adequate proof. She never could figure out what would be adequate proof.
dermatoscope Dermatology Posted Jul 21, 2009 at 9:04 PM
I believe this is termed the "Nancy Pelosi" syndrome, where there is still cardiac but no cerebral activity.
curacao Internal Medicine Posted Jul 21, 2009 at 9:47 PM
wow
cardoc Internal Medicine Posted Jul 21, 2009 at 9:55 PM
Medicare placed me on record as a deceased physician a few years ago. After numerous calls and letters, my nurse took a photo of me holding the daily newspaper with the date visible, and we mailed it to them.
Turns out another physician in a nearby city with the same last name had died and they registered ME as deceased.
A picture is worth a thousand words...
Whatagas Anesthesiology Posted Jul 22, 2009 at 12:01 AM
You know, it's just to damned bad, but I believe that in order to be in full compliance with medicare regs, you're gonna have to kill her.
I'm not sure how that fits into the CPT system, so you may find it tough to bill it. Be sure that you write up the bill beforehand and submit it at the moment of death so that there won't be any timing issues involved. Also, be sure to kill her quickly so that there's no confusion about the moment of death. You might want to check with the AMA - maybe their ethics committee - to see how to best proceed. I understand they have some experience at killing physicians.
When you break the news to her, that might also be a good time to ensure that you are in compliance with issues surrounding death such as organ donation counseling. I'm sure that JCAHO would be happy to provide you with a list of issues you should cover, although they may charge you for it. Attracting their attention always has the potential to generate a site visit, though, so be sure to have your ducks in a row before you call.
I'm really at a loss as to the best method. Gunshots are very messy and family members may object. And, of course, you would certainly like for her to have an open casket. I suppose you could do a lethal injection, but there might be issues with drug dosing if the case gets reviewed. Knives can be very quick, but if you don't have much experience stabbing people you may need to get a surgical consult. Anesthesia is always a quick and easy way, but the expenses of hospitalization for such a trivial procedure might not pass scrutiny. Whatever method you choose, be sure and get preauthorization from the insurer, because her ability to seek reimbursement after the fact will be quite limited.
One would think that offing a patient would be a trivial undertaking, but given our current regulatory and legal climate, the potential risk of reimbursement issues and, of course, the malpractice thing if you bungle it, you might want to go ahead and hire a consultant.
Tough case. Good luck.
basicscience Anesthesiology Edited Jul 22, 2009 at 12:06 AM
dermatoscope, she has no cardiac function either. And with all the Botox, not even any muscle fasciculations. And no spine. Not sure what's keeping her alive, other than lots of hot air. Perhaps a very primitive reptilian brainstem?
hermosasay Anesthesiology Posted Jul 22, 2009 at 2:38 AM
PETTY PELOSI
what drug is she hooked
she is out to lunch
babbling nonsense
maybe she thinks
she has been crowned
QUEEN of double speak
knew when
knew where
knew what
and
she is is charge
heaven help us
we have gone
down the rabbit hole
soon
QUEEN PELOSI
will order
off with our heads
Caffemaven Emergency Medicine Edited Jul 22, 2009 at 3:36 AM
Whatagas: Hilarious. I think one of the funniest posts ever on Sermo! Now go back to work and come up with a billable way to kill this woman and make the pencil pushers happy!
hwhfam Family Medicine Posted Jul 22, 2009 at 12:12 PM
very funny, Whatagas!
dermatoscope Dermatology Posted Jul 22, 2009 at 12:25 PM
A simpler way may be just to call the coroner and ask that this be a coroner's case because of the suspicious circumstances. Really a bummer when uncooperative patients refuse to accept deceased status.
xueelo Pathology Posted Jul 22, 2009 at 3:31 PM
send your pt over to see me....
charesepel Anesthesiology Posted Jul 22, 2009 at 3:36 PM
whatagas, GREAT job on your post. dermatoscope, funny.
wacurity Internal Medicine Posted Jul 22, 2009 at 3:36 PM
A few years ago when I moved my practice and changed the address. Because of overpayment on a couple patients Medicare immediately knew about my change of address and wanted the money. But when it came to the address change so they could send money, it took about 12 weeks.
LouisReznick Family Medicine Posted Jul 22, 2009 at 3:38 PM
Have patient call medicare to try to get reborn.If that doesn't work, have the patient play dead
MedboyIL Pediatrics Posted Jul 22, 2009 at 3:43 PM
Do an MD to MD phone call with Medicare, preferably with the patient in front of you to talk to them as well. Perhaps they screwed up on the name of the patient? Is it a common name? I get patient info sent to me sometimes from insurance companies for the wrong doctor--same name as me but with a DO degree. I have an MD. I also don't see old folks that they're sending me info on. I just laugh and pitch it in the HIPAA trash.
clayjar Rheumatology Posted Jul 22, 2009 at 3:43 PM
Have patient contact the local congressperson's office.
pgakaa Oncology, Hematology/Oncology Posted Jul 22, 2009 at 3:44 PM
Wow--have never seen this before, and I deal with a lot of dead folks.
retireddoc Urology Posted Jul 22, 2009 at 3:46 PM
Send patient a letter: Dear Madam: Medicare tells me that you are dead. Please do not make any more appointments.
drlisam Anesthesiology Posted Jul 22, 2009 at 3:46 PM
I applied for a change of address Medicare # three months ago, still waiting. They are incompetent government employees, government 'educated', probably hired off of some food stamp line in the name of "stimulus".
Tell the patient you can't see her anymore and let her straighten it out. It *is* her "insurance", is it not?
asiaaz Pulmonology Posted Jul 22, 2009 at 3:46 PM
Wow.... and this is the same government who wants to manage health care. We are nearing the end of medicine as we know it. Nice knowing you all....I think you should show this to our fearless leader.
By the way, I love the medical humor on Sermo! Keep it up!
pauljschubert Cardiology Edited Jul 22, 2009 at 3:47 PM
Ask Major Major Major what to do. If that doesn't work row to Sweden.
She also nay not be getting her Social Security check.
duckear Otolaryngology Posted Jul 22, 2009 at 3:47 PM
Reminds me of Monty Python and the Holy Grail
" But I'm not dead yet!" |
