Why Can't I find Someone Else?

Fraud Accusation Risk Turns Off New Providers
With a six–nine month waiting list, common sense suggests that offering neuropsychological dementia evaluations is a good business opportunity. We've been able to deal with the low reimbursement rate by improving efficiency and scale; e.g., doing two evaluations per day rather than just one, while billing less to Medicare per evaluation. However, Medicare is still difficult to work with. For those who care, the National Association of Neuropsychologists (NAN) wrote a statement by Dr. Robert Barth (here) providing advice to neuropsychologists considering working with elders and accepting Medicare. Their advice to people thinking of entering the field is pretty off-putting:
Quite unfortunately, Medicare is an extremely problematic reimbursement system which should probably be avoided if at all possible. The primary problem with Medicare is that it involves numerous regulations which are counter-intuitive and which are are not readily accessible, but which, when violated, will render the doctor vulnerable to accusations of "fraud" (Medicare does not simply accuse people of failing to know the rules, it always uses the word 'fraud') when Medicare discovers that the regulation has been violated.
The risk of being accused of "fraud" is essentially intolerable, and should not be accepted by neuropsychologists. This is the basis of my recommending that neuropsychologists try to avoid Medicare reimbursement. However, this situation is especially intolerable given the fact that most doctors are reimbursed by Medicare at 60 or 70 percent of usual and customary [rate], but neuropsychologists are reimbursed by Medicare at approximately 20 percent of usual and customary [rate]. The rate of reimbursement by Medicare in most states does not even cover the cost of providing the patient with neuropsychological services. When combined with the vulnerability to "fraud" accusations, seeking reimbursement through Medicare is essentially unsupportable from a business perspective.
The situation is made even worse by the unreliability of reimbursement through Medicare. Even though the system claims that some minimal reimbursement is available, is some states the Medicare administrators have demonstrated a concerted effort to avoid ever paying any of the bills. The burden for such failure to pay cannot legally be passed on to the patient, so there is no motivation for the patient to assist the doctor in efforts to gain reimbursement.
This set of circumstances could potentially create a crisis within geriatric service delivery, because of the high need for neuropsychological services in that population, coupled with the almost universal coverage of geriatric patients by Medicare. I have no solutions to offer for this problem at the current time, but I am hopeful that solutions may be developed/proposed as we work to heighten general awareness of the problems. In our practice, when we are asked to see a patient who is covered by medicare, we have found it more economical to provide services on a charity basis rather than to waste time interacting with the Medicare administrative systems–Dr. Barth, for NAN.

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