Author Topic: Medicare Ombudsman  (Read 1638 times)

dedwards

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Medicare Ombudsman
« on: September 28, 2009, 11:32:09 AM »
After months of trying, we received our Medicare Part A provider # Sept. 17, 2008.  As of today, we have yet to receive any payment from Medicare.
You may have read my past cries for help, and I sincerely appreciate your advice.  We finally were able to go through our clearing house, McKesson, and receive Medicare audit trails for all our past claims.  Most were filed the end of August, so we have many that are past the 30 days that Medicare should have paid us. I am now told that we have 98 claims in "suspense", and 32 that will be sent back to us.  Another issue we have is we haven't been able to
get a password to get into the Medicare FISS system.  They are very "backed up" and couldn't tell me when we might get a password.
I was also told that they cannot tell us why or when we can receive payment for the claims in "suspense".  Does anyone have any advice?  We are in a desperate situation and can't get any answers.  When they told me we had all the claims in suspense, they also said there is nothing we can do from our end, it's all up to Medicare.
At this point, I am ready to contact our "ombudsman" but can't find any way to get in touch with him/her. 
Please help!  Any advice will be appreciated. 
Debbie

PMRNC

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Re: Medicare Ombudsman
« Reply #1 on: September 28, 2009, 12:22:47 PM »
If the claims are "suspended" you need to look at the clearinghouse reports or contact them if there is no further information. Suspended claims usually means there is a problem with them before passing them on to Medicare. Look for a common denominator on the claims as well.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

dedwards

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Re: Medicare Ombudsman
« Reply #2 on: September 28, 2009, 01:34:13 PM »
Thank you for your reply.  Our claims went thru the clearing house, and we have a claim audit trail from Medicare showing the claims were accepted.
Medicare told me the claims were in "suspense" status in Medicare, so they made it there. 
I've just called the customer service line at Medicare who checked and verified they were indeed in suspense.  According to her, she went
in and "released" three claims, and per call I can request that three claims be released.  She could not tell me what "suspense" means or why they are in suspense.  From what I understood, that doesn't mean they will be paid now.  It just means she's telling them that it's past the 30 days for payment and asking them to pull them and look at them again.
It's the strangest thing I've ever had to deal with.  What makes it so much worse is I can't get any information or answers from Medicare!
I really appreciate your help. 

Pay_My_Claims

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Re: Medicare Ombudsman
« Reply #3 on: September 28, 2009, 08:33:38 PM »
That is just what medicare does for various reason. I use the CSI/BE system for Medicare claims. There are those that are on the payment floor, those that have been received, those that are in suspense (COB) and those that are suspended for other reasons.  Its like BCBS saying "claim is in adjudication" OMG!!