Author Topic: Help!!How do I complete claim for Medicare Denial EOB ???  (Read 196 times)


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Help!!How do I complete claim for Medicare Denial EOB ???
« on: January 07, 2018, 09:06:58 PM »
I am an LPC in Virginia who has been told by a ne Coordinated Care Plan- CCC- that I nneed to get a denial letter from Medicare, so my clientsí Medicaid part of their plan can pay. Other CCCís have only required a letter saying I cannot bill Medicare. Will Medicare send me a denial letter? Do I complete the CMS 1500 form the same as for regular insurances? When I contacted Medicare, the rep wanrd me to complete the online form clients submit. Iím uncomfortable with this, as the client signs. that, not me.
Iím really struggling here, as Iíve not run into this prior to now, an am very uncomfortable with the Medicare issue since  I canít bill them as an LPC. Iím still trying to get the Ccc to rectify this, but in the meantime, am losing billing.

Thank you for any and all assistance!!!
« Last Edit: January 08, 2018, 05:37:53 AM by hopefloats »
Private Practice LPC in Virginia


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Re: Help!!How do I complete claim for Medicare Denial EOB ???
« Reply #1 on: January 08, 2018, 08:23:20 AM »
We have run into this in the past.  You cannot bill Medicare for a denial because the denial will not be correct.  In order to bill Medicare you have to be enrolled in Medicare as a provider and Medicare does not credential LPCs.  In some states like TX, Medicaid recognizes that Medicare doesn't credential LPCs and they allow LPCs to treat Medicaid patients that have Medicare prime.  I'm not sure how that works in VA.  I would contact them again and explain that Medicare will not enroll you and you are not able to even bill for a denial.  It's possible the person who told you that is not aware that they already know that and don't require it, or it may be possible they don't allow providers who are not enrolled in Medicare to treat patients who have Medicare prime.  My experience is that it's the first scenario.
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Re: Help!!How do I complete claim for Medicare Denial EOB ???
« Reply #2 on: January 08, 2018, 09:31:40 AM »
Michele is right, you cannot bill medicare unless you are enrolled and since they will not allow LPC's to be enrolled you won't be able to get a denial. Some states as mentioned DO know that LPC's cannot enroll and SOME Medicaid plans will pick up but that's not a guarantee. Best to call your Medicaid office and find out. You'll of course also have to be enrolled in your state Medicaid plan for them to even consider the bill. I'd call Medicaid to find out how and if this can be done. Sometimes you can attach a letter to your claim for the secondary payer and site the specific code (Section 1861(s)(2) of the Social Security Act) which excludes LMFTs and LPCs as Medicare providers. I'm not sure this will help and you may have to write off the balance and discuss with the patient for future visits.
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