Medicare frustrations Replies (2)

Medicare frustrations Replies (2)

Randall McFarland, CPO

Hi Listmembers-

FYI To contact your representatives copy and paste:
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Below are more responses to the following post:
Hi Listmembers-
   Verification of coverage
Stephan R. Manucharian, CP recently asked if there was a way to verify
Medicare coverage. I remember almost a year ago an announcement that we would
be able to do just that, but I've heard nothing of this concept since. How
are we to know if we can provide services to someone who may have received
similar care recently or just received an electric wheelchair particularly if
he hasn't told us about it? How can we tell in advance if a shoe attached to
an AFO will be covered?
    Further, we recently received a denial for services rendered to a
Medicare patient because his coverage had temporarily lapsed during the DOS.
This patient didn't tell us that coverage had lapsed and I don't know if he
was notified or not. He has no money. We had provided services prior and
received payment and to my knowledge, there is no way to verify current
eligibility with Medicare.

    Serial denials
Medicare has a habit of issuing multiple denials on a claim. For instance,
they'll deny for one reason and when we accommodate and resubmit the claim,
we will receive a denial for a completely different reason. This policy is an
obvious stalling tactic. Do they think we'll just give up after the first
denial? Why don't they look for all the possible reasons for denial while
they have it in their hands the first time? Do they get paid for each time
they handle a claim? It will save everyone much time and effort if Medicare
was required to disclose ALL reasons for denial of the claim in question.

Have you experienced this?
   We can continue to submit to the risk of providing services without
assurance that we'll be paid, but this only perpetuates an unfair situation.
    What can we do? Because Medicare policy is determined by Congress, I
suppose that until policy is changed, Medicare will refuse to go the extra
effort or providing preauthorization or verifying coverage. Let's ask our
lobbyists for direction as to best affect a change in Medicare laws so we can
verify coverage and obtain ALL reasons for denial at once.
    Will those knowledgeable on this get back to me with information about
what we can do as a group? I need specifics here, and I'll get back to the
list with the responses.

Randy McFarland, CPO

RESPONSES

I cannot promise or claim that I accomplished anything for you. But in
asking my questions on Medicare, I did get a meeting with a lawyer who was
in the middle of writing a second draft of a Medicare reform bill. The bill
is slated to be introduced in the spring and is to be budget neutral, so it
may have a chance.

The bill is S1738 and seeks to establish performance guidelines for the
Medicare contractors and to give CMS control over the contractors. The
re-write should be available in a few weeks and if you like what it says I
suggest that we all get to writing and generating some support for the bill.

I hope that I have helped in some small way.

Pat Shannon
President/CEO
Healthcare Management Solutions, Inc
The Nations O&P Billing Service
402-898-0561 Fax 402-898-0564
<Email Address Redacted>

I cannot promise or claim that I accomplished anything for you. But in
asking my questions on Medicare, I did get a meeting with a lawyer who was
in the middle of writing a second draft of a Medicare reform bill. The bill
is slated to be introduced in the spring and is to be budget neutral, so it
may have a chance.

The bill is S1738 and seeks to establish performance guidelines for the
Medicare contractors and to give CMS control over the contractors. The
re-write should be available in a few weeks and if you like what it says I
suggest that we all get to writing and generating some support for the bill.

I hope that I have helped in some small way.

Pat Shannon
President/CEO
Healthcare Management Solutions, Inc