14 June 2010


Well, as of today, we are getting reimbursed 21.3% less than the previous baseline level for medicare patients. This SGR mess has progressed right beyond tragedy into farce. I feel bad for all the small practitioners out there who are highly dependent on their week-to-week cash flow to pay the rent, office staff, etc. This could be a real hurt for them.  It won't damage our practice, since we are big enough to buffer the stutter in the revenue.

One thing I had not reckoned with is the havoc this wreaks on the billing offices. I was speaking with out rep at the very large ER billing firm we use for our claims processing and collections. They bill 5 million ER visits annually.  He was on the verge of tearing his hair out. They have repeatedly had to jury rig their computers to hold claims  for a certain payer, not something that is a normal part of business, then send all the claims out at once, then hold them again, then apply a new fee schedule and send all the bills out at a lower rate, then hold them again and rebill at the old, higher rate, then reconcile the accounts for the partial payments received.  For me it's an annoyance and a strategic threat. For them, it's an operational nightmare.


  1. 21.3%, or 11.3%?

  2. Ha Ha!

    That's what I get for doing math in my head!

    If you're going to be a pharmacist, consider this example of a doctor's math skills when you see a prescription with unusual dosing (especially for a child). Just sayin.


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