Monday, December 14, 2009

'Change Request 6540' and the Dem's Proposed Medicare Expansion: Bad News for Insurers and Providers

Senator Lieberman (I-CT) has come out against the Medicare expansion, earning the vitriolic spittle of the left leaning commentariat. Undeterred, this new healthcare 'Sen. No' seems to be hanging tough in opposition to alleged busting-busting government insurance creep.

While thinking through the implications of this, the Disease Management Care Blog ran across this CMS document that deals with updates to the hospice benefit.


Unless you're a technical writer, compliance officer or bureaucratic weenie, your reaction to opening this 'CMS Pub 100-04 Medicare Claims Processing Transmittal 1870 Change Request 6540' was probably similar to the Disease Management Care Blog's: egads, how on earth is a health care entity supposed to put up with all this detailed and soporific minutiae?

The DMCB discerns three lessons:

1. Behold the Medicare approach to the 'Hospice Benefit.' By the way, this is also the approach to pay-for-performance, inpatient reimbursement, physician fee schedules, medical devices, all forms of rehabilitation, demonstrations and the myriad other touch points between the health care delivery system and government-run health care. The Dems may call it Medicare, providers call it a hassle. And folks wonder why the AMA isn't supporting this?

2. There is no better example that explains why Medicare's administrative costs are so low. It probably takes an afternoon for a CMS full time equivalent (FTE) to develop a 'Change Request 6540.' It takes a full time position on the delivery side to deal with it.

3. Finally, armed with forms like this, who can argue that Medicare won't crush any commercial insurer? Think the regional not-for-profit Blue will also be able to 'require' providers in their network to deal with Change Request Form 6540? No way.

Maybe the Connecticut Senator has a point.

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