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evans1035:
Medicare nightmare (continued)...
Because Medicare backdated the deactivation date of old ptan and npi to 3/5/10, and made new grp ptan and grp npi effective 5/26/10, they are not going to pay her for charges to these patients, technically from 3/5 until 5/26/10 dates of service (although they had already pd 3/10 dates before they sent whatever they sent to the old address). In one of their letters they say something that they have to at least make eff date of new # back 30 days, which would be 4/26. When I asked rep about it, she said oh, that's for revalidation, and this is now considered a new application, so it doesn't apply.
How do you ever know if the rep you're speaking to has any clue about all of this?
THIS IS DROWNING ME!!! Provider is also worn out from all this, and says just bill under the new #. She wants me to also rebill the charges in that gap also and see if they pay. From what I could figure out from the 42 CFR 524.520 they quoted, that could cause more trouble and I left her a message to that effect.
Sorry this is so long, but I have so much paper from this nightmare, it's hard to explain everything.
My actual question at this point is: What do I do about all the other carriers (BCBS, Medicaid, UHC, Aetna, etc.)? I've always submitted all those on her tax ID and had her address on claims, and 1099s she gets from them show her tax ID #, so do I tell them she now has a grp NPI? What if Medicare and other carriers ask for money back? This was not any attempt to defraud anybody, and as I said, it is just her in her practice. I'll have her Sept billing in the next few days, and I don't know what to do about the NPIs or how to ask carrier about all this without having more issues.
DID I MENTION THIS IS DROWNING ME? I WANT TO QUIT BILLING NOW. THIS IS MAKING ME PHYSICALLY ILL...
DMK:
I can only offer you what I went through.
You won't have the same run around with other insurance companies. Just call provider relations as you have time and find our what they want you to fill out. We ran into the same thing with a group NPI vs. individual NPI. We were just a sole proprietor so the group NPI we were told to get was wrong. Long story short, regular insurance companies will have A form and will make the changes easily.
Medicare, on the other hand, was a nightmare for us when we moved our office. We happened to do this right when they were changing vendors too. So a one line address change took me 9 months.
Fill out the application form being extremely careful to dot all the i's and cross all the t's. When you show the doctor's SS#, EIN, PTAN, and NPI they will finally all be joined on one form. You can then show the old address start and stop dates AND the new address start dates.
Once they have it scanned in their system, you can speak to someone who has it all on their screen. The hold time on the phone is a killer, so set aside a day and time to devote to it and be patient. It sucks, but it has to be done.
Your doctor will have to switch to EFT if they haven't already done so. Medicare is eliminating checks. I was scared to do it, but it has worked great so far.
It took a long time for me because I didn't know what I was doing. I ultimately got it right, and we got paid on everything. I'm ashamed to admit it, but I cried when the first payment came in. Seriously.
Best of luck to you, and if you need help finding the right phone numbers I'll gladly help you!
This is a great forum and all the people here are so helpful. We've ALL been where you are!
Michele:
The problems that you are describing are the reason that we started doing Medicare credentialing as a service. Many providers that just move their location, or change from their ss to an EIN, but do not know how to do the paperwork Medicare requires, end up with a huge headache, or losing a lot of $$. Once you understand exactly how Medicare works and what they require it is not as much of a nightmare. I don't mean to minimize the situations you went thru because I completely understand. But having done over a thousand Medicare CMS forms, I know exactly why Medicare requested what they did, and why the provider/biller didn't understand. Since most providers/billers don't need to complete CMS forms on a regular basis they do not know what needs to be completed and why. AND lets not forget to mention that Medicare often "updates" the CMS forms, which changes the whole thing up just a little! ;)
dekenn:
How long do we wait for Medicare (we are under Highmark Medicare) to assign the application to a reviewer? I submitted the new application online (we weren't in Pecos, and had to switch from his ssn to ein), got the certified mail confirmation (mailing in the certification statement and EFT form) on August 9. Finally called last week, the rep confirmed they received it, but it has not been given to a review yet. At what point can we complain about the delay? Any one else experiencing these delays???
Michele:
Per CMS guidelines, they (Highmark) have 120 days to complete the application. If they require additional information or corrections, the 120 days starts over from the date they receive the corrections.
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