AMA’s article “Medicare’s doctor records riddled with errors”–correct terminology or not?

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The July 8th copy of the American Medical Association’s publication (vol 56, No 13) featured the article (by Charles Fiegl) “Medicare’s doctor records riddled with error,”in my opinion, only shows one side of the equation. Having been involved in the process of Medicare’s re-attestation, it was obvious the new software program being used by medicare, needed provider information updated. It’s not like the doctor’s information was really what I’d call riddled with errors, but rather possessed information that no longer fit into the new program’s software format?

My former office had been affiliated with Medicare for many years without any issues re: information upgrades. All providers that were members possessed an ID number assigned by Medicare as well as tax ID numbers etc. that were linked to current billing addresses. I do not doubt that the information needed updating secondary to people moving, retiring, change in phone numbers etc., but rather than called errors, I feel the more appropriate terms would be simply, information upgrade. The new medicare software is more organized as well as complicated as it links in with several other government agencies; NPPES (Per author C. Fiegl, “National Plan and Provider Enumeration System that providers obtain identifiers from that allow them to contract with public and private payers”) as well as PECOS (Per author C. Fiegl, “system which allows providers to participate in Medicare and Medicaid.”)

The attestation process for my former office was quite complicated as our official title, recorded with the IRS, had to be the same as what Medicare posted in their records. Over time, the clinic name had been shortened etc secondary to what was imputed and allowed by the different software programs involved. OurĀ  re-attestation process required additional help in that the new medicare software only had so many place holders for our name. Fortunately, we did have great help from an experienced representative and the issues were solved, but it did take a deal of effort on both of our parts. We also had to apply for another provider # as the format for reporting our data, no longer worked in the new software program. The representative didn’t accuse us of errors as our information had been current per the times and all in all, it was obvious that Medicare’s new software program was much more sophisticated/organized in the amount of information it contained and our old data had to be updated in order to be compatible.

The issues being addressed in this article will be ongoing as changes will continue to be a constant over time. The key will be the check/balance system imputed by Medicare/Government to follow-up on the changes of its providers and make sure the appropriate communications between involved parties take place when needed.

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