I received a number of interesting emails from a number of doctors in response to Medicare Provider Bureaucratic Nightmare, a post regarding the plight of John Peters, a practicing psychologist, and his quest to obtain a Medicare Provider Number.

Please read the above link if you missed the original article. Here are some responses from doctors willing to sign their names.

War of Attrition

Dr. Denise Szczucki writes

Dear Mish

I am a physician and went through this exact scenario when I had to change my tax ID number a few years ago. 25 percent of my income was held up for over 6 months while the re-credentialing took place.

Two things that helped me were:

  1. I hired my biller to do the work. An outside party is less emotional since it is not their food money on the line.
  2. I redid the entire application including the canceled check. They pulled that canceled-check stunt with me too.

This is a war of attrition.

CMS is a nightmare and it used to be so simple. When I renewed in 2000 it took a month and a single application, no check, to get it done. Now you have to keep calling, faxing and mailing (certified ideally) until it gets done and it takes forever.

Even then it will take months to get the first set of checks.

Good Luck
Dr. Denise Szczucki

Incentives to Delay

Mark Woodward, O.D. writes …


It’s not really hard to understand. By federal regulations Medicare should credential “any willing provider” who meets the credentialing process. However, Medicare is going bust as we speak.

Medicare simply has no incentive to increase provider roles. One way to limit expenditures is to limit the number of providers. This is the same tactic used by HMO’s and some other health plans.

In a more global context I believe the transition to socialized medicine in this country will be exceptionally difficult. The only way government can move to a completely socialized delivery system is to co-op different participants in the delivery system and put the pressure on the non co-opted participants.

Watch for government to increase contracting with “Healthcare delivery systems” like UHS, Tenet Healthcare, and HCA.

While these delivery systems may be more efficient than civil service workers, they will also swallow greater and greater share of the reduced reimbursement amounts. Ultimately, government will abandon their co-opted partners when citizens are fed up with reduced benefits, limited access, and poor quality. People will then ask for a fully socialized system administered by the government.

New and future graduates of medical training programs can only hope to start at salaries higher than the accountants hired by the feds to track the program. Those New doctors will become debt slaves. They graduate $250,000 to $350,000 in debt and will have to accept any wage. Veteran doctors will quit en mass rather than put up with all the bureaucratic red-tape with much less reimbursement.

The sad thing is heath care expenses do not substantively alter our countries productive output. They really shouldn’t be considered as part of the GDP just like the profits from the derivative finance industry should never have been considered part of the GDP.

Mark Woodward, O.D.

Suggested Course of Action for Dr. John Peters

Allen Bennett, a retired M.D. has these suggestions for Dr. John Peters

Hi Mish

Regarding “Medicare Provider Bureaucratic Nightmare“, John Peters might consider sending a letter by registered mail to Marilyn Tavenner, COO, Centers for Medicare and Medicaid Services, 200 Independence Ave S.W., Room 445-G, Washington, D.C. 20201 with copies to Senators Boxer and Feinstein.

He needs to include the names of all involved “analysts”.

The bureaucratic nightmare of John Peters appears to be a wonderful way to cut health care costs while keeping a largely unnecessary intermediate bureaucracy “busy”.

I have often worried about newly-minted health care providers and their ability to get on approved provider panels, so they can bill and get paid. It used to be no problem, but apparently it is now.

Your daily analysis is always enlightening. Keep up the great work!

Allen Bennett, M.D.


Here is an email from reader Charlie Smith who sums up the situation nicely.


The mess described by Dr. Peters goes to the core of the issue of bureaucracy, which is political power and the triumph of “who you know” over “what you know”. When even a competent person such as Dr. Peters must go to a high ranking bureaucrat (his congressman) to get even a simple task accomplished, our Constitution (a government of laws, not of men) is shredded.


Mike “Mish” Shedlock
Click Here To Scroll Thru My Recent Post List