Media Matters Still Has Trouble With the Word "Provider," Owes Correction

Media Matters knows nothing of what it speaks and continues to ignore the facts when it deals with health care laws, compliance, and regulations. In its zeal to prove Lee Stranahan wrong, MM ignores the fact that Planned Parenthood does not provide the mammography service. MM stated:

Team Breitbart is still challenging our perfectly accurate statement that Waco’s Planned Parenthood provides mammograms, apparently arguing that in order to provide a service it is necessary to perform that service. But this reasoning suffers an obvious and fatal flaw: it ignores the costs associated with providing a service.

[…]

We pointed out that Planned Parenthood in Waco pays for mammograms to be performed.

Let’s read on, shall we. Its narrow interpretation, simplistic definitions list, and cute sandwich analogy are completely flawed as there are layers of compliance, coding, and state/federal regulations health care practitioners/providers must abide. Let’s take this step by step for the Media Matters scribes, so they can follow along on who legally “provides” the service according to health care regulations, by which they which must be applied to this scenario to be accurate.

Step 1:

Patient comes in to Planned Parenthood and needs a mammogram.

Step 2:

PP states they must refer out for that service as they do not provide mammograms on site.

Step 3:

Patient schedules an appointment with a contracted provider.

Step 4:

Patient goes to the contracted facility (i.e., provider, not PP) for the mammogram study. This is the facility that actually provides the mammogram study.

Step 5:

Contracted provider/facility sends bill to PP (according to PP).

Step 6:

PP pays the service provider’s bill from the funds from the Komen for the Cure Foundation private grant money.

Question: Because Komen provided the funds through a grant to pay for the test, did Komen provide the test? Did Planned Parenthood provide the test? According to the law, no. Providing remuneration does not equate to providing the service. For example, insurance companies provide access to health care through provider networks and reimburse those said providers–that does not mean the insurance companies “provide” the service.

Additionally, because PP does not provide the mammography study itself they do not have professional liability for the study–more proof that they are not the provider. Furthermore, the contracted provider assumes all of the liability for the study, including compliance of the equipment, accreditation, test administration, and reading of the results. Planned Parenthood; however, does not have any ties to this liability–further delineating them as a non-provider.

Another issue is how is the contracted provider bills for the mammogram study. Health care providers must use CPT and ICD9 codes in order to bill for services provided. How is PP receiving its bills to access the Komen Funds? However, this is not so much the main issue, rather the core issue here is further defining for our dear friends at Media Matters the meaning of “provider.”

Regardless if the contracted facility uses the CMS 1500 when they bill PP or not, it is unmistakable how the federal guidelines interpret the meaning of the word provider. If you look at the CMS 1500 claim form you will see many blocks of specific information that must be filled in.

Now, let’s look at the CMS 1500 claim form in more detail and look at Boxes 24 a. and b., 25, 31, 32, and 33. All of these blocks require information on the provider of the service; the only block that asks for referral information is block 17; this block can also be left blank if there is no referring practitioner. To further define:

Box 24 a.: Date of service; Box 24 b.: Place of service–NOT at PP facility.

Box 25: Provider tax ID number–the provider is NOT PP.

Box 31: Signature of physician or supplier (of billed service)–NOT PP.

Box 32: Service Facility Location Information–NOT PP; Box 32 a.: NPI number (National Provider ID)–NOT PP; Box 32 b.: Taxonomy number–NOT PP.

Box 33: Billing Provider and Info.and Phone Number–NOT PP.

Now that I have gone through this step-by-step explanation, what is it that Media Matters does not understand about the definition of a “provider” as it applies to health care regulations and billing? It is clear that the health care industry has its own language and it is crystal clear that Media Matters is ignorant:

It’s time for Media Matters to stop dodging the responsibility it owes its readers and the truth. It’s time for them to issue a correction. We’ll let you know when they decide to take honest reporting seriously and do so.