Patient complaint to Medicare

heartyoga

Guru
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Cookeville
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We had a patient in 2015 that claimed he had written a letter of complaint against our doctor because he felt our office "charged excessively". It was a new patient visit and we charged 99204. Medicare paid us $19.00 and the rest was charged to him for deductible. He nitpicked that our doctor did not spend 45 minute face to face, and claimed doctor did not examine him thoroughly. His problems are moderate and we have the documents to provide it. We didn't want to tangle with him so we just wrote off whatever he owed around $135 and wrote him a letter of termination. Fast forward to present, he wrote another letter saying he is again sending the original letter to Medicare because Medicare did not respond to him, and admitted that yes the doctor did see him and spent some time with him and he is willing to pay $45 for what he felt the visit is worth.
Our doctor is wanting to write a rebuttal letter to Medicare to clear his name. He is worried that this patient's invalid complaint may be put in a file and cause us trouble.

My question is:
1. What does Medicare do to "invalid" patient complaints? It is obvious that the reason this patient complaint is because he was charged his share of deductible.
2. Does Medicare compile a physician complaint file?
3. Should we write a letter of rebuttal to Medicare? Or just let it be?

In my opinion, (i hope) the Medicare people can see this is just a patient not wanting to pay. I don't think it even deserves anybody's time and attention. However, our physician is worried if someone will actually act on the letter and cause trouble. He worked too hard to build his practice and feels bad that his integrity is being questioned.

Any feedback would be appreciated.

Thank you.
 

thomas7331

True Blue
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In my experience, this is a pretty common complaint to receive from patients who often don't understand the costs involved in running a medical practice and I would imagine that Medicare sees a lot of these. If your documentation supports your charges, and if this is an isolated instance, your physician really does not have anything to worry about. I would expect that Medicare does have to keep all complaints in their records, but unless they contact you for additional information, I don't think there's any need to write a rebuttal letter - they will certainly get in touch with you if they need your side of the story.
 

ahguzman

Networker
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Patient complaints can be unnerving, even if unsubstantiated. If your physician is truly concerned and fearful of scrutiny from Medicare, perhaps he should consider having an auditor or coder review the chart and determine if it was coded properly (if he hasn't done so already). If he's already had someone look at the documentation and they agree the documentation supports the level submitted, this should ease his mind.

AHG, CPC, CPMA
 

heartyoga

Guru
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Cookeville
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Thanks everyone

Thanks everyone for your inputs. I called Medicare and the rep said there is nothing we need or can do about it. They don't even have an address where to send the letter. Medicare said that they review the patient's letter and if they deem it is invalid they don't do anything about it.
 
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