Medicare problems

I wonder if other billers are running into the same problems we are with Medicare. For the fifteen years we have been doing medical billing we found Medicare to be one of the most straightforward reliable insurance payors. They have their rules to follow, but if you followed them, the rest was easy. On September 1, 2008 many Medicare offices changed carriers and that’s when our problems started.

It wasn’t just our local Medicare either. One of our services is obtaining Medicare credentialing for other providers so we are contacting different Medicare carriers all over the country. In September we found that we couldn’t even get through on the phone to many carriers. We could continually hit redial or wait on hold with music playing all day and never get to a representative. It took us days to get the mailing address for one Medicare carrier just to mail in the application.

Some providers are calling us looking for help as they applied for Medicare credentialing months ago and still haven’t heard anything. We worked with one provider for over two weeks trying to help him find the status of his application and neither one of us was ever able to get through to a representative. We don’t know if he ever did learn if he was credentialed or not.

One of the problems we encountered with our local Medicare was denials on claims for bogus reasons. We would call and ask what this was all about and were told that it is an internal problem they are working on. Well here it is, almost the beginning of February and we still are having trouble getting some of these claims paid. They still haven’t worked out their internal problems. If our internal problems lasted this long, we wouldn’t have any clients left.

Our most recent problem with Medicare claims are for a specialty where the patient is returning regularly for the same service. Now Medicare is paying at a much lower rate. When we called to inquire, no one could give us an answer. They could not answer one question. It was like they took people off the street and told them to answer phones with absolutely no training. We were told to call ‘telephone reopening’. When we asked why we were asking for the claim to be reopened, they couldn’t tell us. They couldn’t even say if telephone reopening would reprocess the claim. So is this provider just supposed to accept this lower rate now?

What happened to our old reliable Medicare?

I hope not Gone Forever! 😦

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