MEDICARE DOOMED?

greenspun.com : LUSENET : TimeBomb 2000 (Y2000) : One Thread

www.garynorth.com

Look under WELFARE PAYMENTS, then under the new NOV. 15 post .

Seems Oregon has just woken to the fact that there is such a thing as inter-system testing! Their systems won't even talk to each other.

Hope anyone reading this doesn't expect anything from them.

-- profit of doom (doom@helltopay.ca), November 15, 1999

Answers

Worries Over Medicare Surface in Oregon

Direct link: http://w ww.oregonlive.com/business/99/11/bz111202.html

Medicare hears bleak diagnosis of Y2K readiness

Medicare's chief information guru calls it "a much bigger problem than I anticipated."

A Medicare contractor calls it a "really grave" concern.

An Oregon medical industry executive calls it "a potentially lethal situation."

They aren't talking about the Ebola virus. They're talking about a bug of a different sort: Y2K.

The Year 2000 computer problem has lodged itself in the weak spot of the nation's Medicare system, which provides medical insurance coverage for 38 million elderly and disabled Americans. That weak spot is the computerized connection between the nation's 800,000 doctors and Medicare's 75 contractors, which process claims on behalf of the federal government.

If the electronics claims system doesn't work, physicians wouldn't be paid by Medicare for weeks, if at all.

Even in cases where both Medicare and physicians have Y2K-ready computer systems, the electronic partners are experiencing failure rates of as much as 20 percent when they hook their systems together in tests. But the fact that worries Medicare watchers the most is that 98 percent of the nation's doctors, hospitals and other health providers haven't yet tested their systems with Medicare, according to an Oct. 11 report in American Medical News, published by the American Medical Association.

"We have no reason to believe that physicians in Oregon are any different than physicians in the rest of the country," said James Kronenberg, associate executive director of the Oregon Medical Association. "This is a potentially lethal situation."

Claims-filing failures wouldn't be lethal to patient care. But significant disruptions in the Medicare reimbursement system -- either from improperly submitted claims or from a surge in paper claims -- could create cash-flow nightmares for medical clinics and hospitals that rely on reliable Medicare payments to keep their operations going.

"Quite frankly, that's our biggest single concern at this point," said Gene Eberhardt, Medicare coordinator for Portland-based Medicare Northwest, which processes more than 1.5 million hospital claims a year in Oregon, Washington and Idaho. "We and HCFA have really grave concerns about what will happen if they cannot submit those claims."

HCFA, the Health Care Financing Administration, is the federal agency that oversees the Medicare and Medicaid programs. The agency has warned doctors and hospitals that it will not make payments on improperly submitted claims.

Oregon and Washington doctors generally file Medicare claims through Noridian Government Services, the Medicare contracting arm of Blue Cross Blue Shield of North Dakota. About 77 percent of all Noridian's claims are filed electronically.

As of Nov. 5, Noridian had completed tests with only 92 medical clinics, billing services, clearinghouses and vendors that file Medicare claims in Oregon, Washington and four other states. Those 92 clinics and businesses file about 17 percent of the total number of claims Noridian receives each year.

Of the 92 tests, only three or four had major failures, said Brett Wyman, who oversees testing of physician claims for Noridian Government Services. Causes of the failures -- either Y2K date problems or merely incorrect test procedures -- were unclear, he added.

In Oregon, Kaiser Permanente's physician claims vendor, Companion Technologies, supplied new software to the health system after its test with Noridian turned up glitches that could have affected a tiny percentage of patients. Kaiser says the desktop software will be installed and tested this month and next. Kaiser's hospital claims passed testing with no errors or failures.

Oregon physicians who participated successfully with Noridian ranged from the large Providence Medical Group to Dr. Stacy Clark, a La Grande podiatrist, to Telecom Computer Services, which files claims for 160 clinics.

The Portland Clinic was one medical group that participated indirectly in the Noridian tests. The clinic contracts with McKesson HBOC to file its Medicare claims, said John Jacquot, assistant administrator. McKesson files 1.1 million claims a year with Noridian on behalf of The Portland Clinic and others.

One medical group that apparently has not yet tested with Noridian is University Medical Group, the physicians that serve Oregon Health Sciences University.

"There hasn't been any federal end-to-end testing that I'm aware of," said Ronald W. Schumacher, OHSU's chief information officer.

Along with other Y2K project chiefs, Schumacher said he hadn't been contacted by the federal government about the need to conduct joint Medicare tests.

To overcome the information gap, the Health Care Financing Administration has launched an all-out, 11th-hour effort to persuade doctors to test their systems.



-- Linda (lwmb@psln.com), November 15, 1999.


Question to any polly lurking: What exactly does lethal mean to you?

"An Oregon medical industry executive calls it "a potentially lethal situation."

-- db (dciinc@aol.com), November 16, 1999.


Once again the "Testing" aspect rears its ugly head.

According to Mr. Way from IEEE when Humpty (the system) is put back together again, hold onto your hats!!

-- David Butts (dciinc@aol.com), November 16, 1999.


Yes, this is the very reason I raised my rating from a 6.5 to an 8+ (certainly not ruling out a 10) not to mention other reasons. When I read the status of the Medicare and Medicaid, (last month I believe it was), I had to no other conclusion to come to. I'm convinced a depression is in the bag.

What really gets me, is when I tell people about Medicare and Medicaid (the terrible shape it's in) all I get is "But this doesn't affect me" or "Let those on welfare work, it will be good for them" or "so what?" I mean come on, they can't see any overall supply chain implications whatsoever. Somehow they think the economy will be just fine if Medicare/Medicaid can't function. It's a very large industry. We won't be ok if they don't fix the problems, which I think they won't.

-- Larry (cobol.programmer@usa.net), November 16, 1999.


on medicare: Relative is an independant pharmacist. he files claims for medicare payments on line through what he calls a 'switching company'. I believe it is like the ISP for your internet station, but specialized for pharmacy matter. Three weeks ago,the switching company dialed in new y2k compliant software. since then he has been unable to make on-line connection with the region 4 medicare processing sender. The software company and region 4 blame each other. no guess as when it will be fixed. meanwhile, billing has to be done by paper the old fashioned way. Needless to say payment is delayed. At some point he will have to go to charging the patient full price and letting them submit the paperwork and wait for a refund. or he can go out of business. What i find disturbing is three weeks and no solution to what should be a minor problem. It does not presage good things when real problems come in bunches

-- Noone (noone@none.com), November 16, 1999.


Meant region four processing center vis sender. sorry.

-- Noone (Noone@none.com), November 16, 1999.

Moderation questions? read the FAQ