What is the response to the Kos repudiation? I’ve not come across one yet. It appears that Kos might be correct on this one. Most of those denials from Medicare seem to be for technical issues, attempts at fraud, bad information, sent to the wrong place, etc. Etc. Also, the fact that a private insurer “approved” a claim but merely paid a dollar out of 20 on some claims is not quite on par with the fact that Medicare pays most bills for its many participants.

I’m afraid so far this looks like a myth.

As Kos points out, when you rightsize for the denial code, Medicare pays most everything legitimate based on need and not cost.

I thought you might want to reference my original post on this “Medicare revelation”, it’s here: http://www.hsabenefitsconsulting.com/blog then it took off on the internet when http://www.bigovernment.com picked it up.

Since I found this report and posted it on October 5th, I have received many comments from doctors, patients, and clerical staff giving their accounts of how Medicare is inconsistent in claims denied and how the Medicare reps that they call seldom give the same answer.

Here is an example:
“Our practice had over $250,000.00 of outstanding claims that were clean claims that were denied for no reason other than government incompetence. We finally got CMS’s attention by informing our patients (we have a long waiting list) that we would place all of our patients on the waiting list indefinitely until we got paid for the surgeries we had already done.

The patients began writing and calling and pressuring CMS. CMS offices accused us
of fraud, and were dishonest to our patients by telling them it was our problem, not theirs. With help from Senator Pat Roberts, we were finally able to receive payment for these improperly denied claims. Our bariatric office staff spent 60% of their time for several months trying to resolve these issues. This was time away from processing
new patients, and running the rest of our practice. This is one example of the horror stories that await all physicians when the government has absolute power of the purse.

How many small businesses
can afford to carry a quarter of a million dollars in accounts receivable for nine months? How many can afford the staff resources and lost revenue it took to sort this out?

I have seldom witnessed such egregious practice in my surgical career.”

These are percentages. That means they are standardized for the number of people.