Medicare hears bleak diagnosis of Y2k readiness ("really grave")

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Medicare hears bleak diagnosis of Y2K readiness

The Millennium Bug may hit the electronics claims system that pays physicians and hospitals

Friday, November 12, 1999

By Steve Woodward of The Oregonian staff

Medicare's chief information guru calls it "a much bigger problem than I anticipated."

A Medicare contractor calls it a "really grave" concern.

An Oregon medical industry executive calls it "a potentially lethal situation."

They aren't talking about the Ebola virus. They're talking about a bug of a different sort: Y2K.

The Year 2000 computer problem has lodged itself in the weak spot of the nation's Medicare system, which provides medical insurance coverage for 38 million elderly and disabled Americans. That weak spot is the computerized connection between the nation's 800,000 doctors and Medicare's 75 contractors, which process claims on behalf of the federal government.

If the electronics claims system doesn't work, physicians wouldn't be paid by Medicare for weeks, if at all.

Even in cases where both Medicare and physicians have Y2K-ready computer systems, the electronic partners are experiencing failure rates of as much as 20 percent when they hook their systems together in tests. But the fact that worries Medicare watchers the most is that 98 percent of the nation's doctors, hospitals and other health providers haven't yet tested their systems with Medicare, according to an Oct. 11 report in American Medical News, published by the American Medical Association.

"We have no reason to believe that physicians in Oregon are any different than physicians in the rest of the country," said James Kronenberg, associate executive director of the Oregon Medical Association. "This is a potentially lethal situation."

Claims-filing failures wouldn't be lethal to patient care. But significant disruptions in the Medicare reimbursement system -- either from improperly submitted claims or from a surge in paper claims -- could create cash-flow nightmares for medical clinics and hospitals that rely on reliable Medicare payments to keep their operations going.

"Quite frankly, that's our biggest single concern at this point," said Gene Eberhardt, Medicare coordinator for Portland-based Medicare Northwest, which processes more than 1.5 million hospital claims a year in Oregon, Washington and Idaho. "We and HCFA have really grave concerns about what will happen if they cannot submit those claims."

HCFA, the Health Care Financing Administration, is the federal agency that oversees the Medicare and Medicaid programs. The agency has warned doctors and hospitals that it will not make payments on improperly submitted claims.

Oregon and Washington doctors generally file Medicare claims through Noridian Government Services, the Medicare contracting arm of Blue Cross Blue Shield of North Dakota. About 77 percent of all Noridian's claims are filed electronically.

As of Nov. 5, Noridian had completed tests with only 92 medical clinics, billing services, clearinghouses and vendors that file Medicare claims in Oregon, Washington and four other states. Those 92 clinics and businesses file about 17 percent of the total number of claims Noridian receives each year.

Of the 92 tests, only three or four had major failures, said Brett Wyman, who oversees testing of physician claims for Noridian Government Services. Causes of the failures -- either Y2K date problems or merely incorrect test procedures -- were unclear, he added.

In Oregon, Kaiser Permanente's physician claims vendor, Companion Technologies, supplied new software to the health system after its test with Noridian turned up glitches that could have affected a tiny percentage of patients. Kaiser says the desktop software will be installed and tested this month and next. Kaiser's hospital claims passed testing with no errors or failures.

Oregon physicians who participated successfully with Noridian ranged from the large Providence Medical Group to Dr. Stacy Clark, a La Grande podiatrist, to Telecom Computer Services, which files claims for 160 clinics.

The Portland Clinic was one medical group that participated indirectly in the Noridian tests. The clinic contracts with McKesson HBOC to file its Medicare claims, said John Jacquot, assistant administrator. McKesson files 1.1 million claims a year with Noridian on behalf of The Portland Clinic and others.

One medical group that apparently has not yet tested with Noridian is University Medical Group, the physicians that serve Oregon Health Sciences University.

"There hasn't been any federal end-to-end testing that I'm aware of," said Ronald W. Schumacher, OHSU's chief information officer.

Along with other Y2K project chiefs, Schumacher said he hadn't been contacted by the federal government about the need to conduct joint Medicare tests.

To overcome the information gap, the Health Care Financing Administration has launched an all-out, 11th-hour effort to persuade doctors to test their systems.

You can reach Steve Woodward at 503-294-5134 or by e-mail at stevewoodward@news.oregonian.com.

-- Homer Beanfang (Bats@inbellfry.com), November 12, 1999

Answers

Claims-filing failures wouldn't be lethal to patient care. But significant disruptions in the Medicare reimbursement system -- either from improperly submitted claims or from a surge in paper claims -- could create cash-flow nightmares for medical clinics and hospitals that rely on reliable Medicare payments to keep their operations going.

"Quite frankly, that's our biggest single concern at this point,"

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Patient care would not be lethaly affected if the care facility closes its doors due to lack of funds?

Disconnect.

-- Mitchell Barnes (spanda@inreach.com), November 12, 1999.


Not that any of this surprises us ...

Since it is so close now, no time left, we will take this opportunity to out the fact that it was, indeed, OHSU where we worked and experienced nightmares of unimaginable proportions.

No surprise that they're clueless! The stories we could tell ...

DON'T BE IN A HOSPITAL ANYWHERE NEAR ROLLOVER !!!!!!!!

Getting on this Forum when we quit working at the Hospital saved our sanity :-)

-- Ashton & Leska in Cascadia (allaha@earthlink.net), November 12, 1999.


There's at least one segment of the population that may not view new records on the NASDAQ as very important.

-- Dave (aaa@aaa.com), November 12, 1999.

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