Medicare Advantage Claims Problems
Elizabeth Park
Description
Collection
Title:
Medicare Advantage Claims Problems
Creator:
Elizabeth Park
Date:
5/17/2022
Text:
Hello all,
As always, I am sure that we are all probably experiencing the same issues with MA plans. I am just wondering if any of you have figured out how to deal with this one.
We do a fair amount of custom foot orthotics and as you all know, Medicare doesn't cover them. However, many Maine Medicaid (Mainecare) plans do. In this scenario, if someone has any sort of Medicare plan as primary, all we need is an appropriate denial code (PR) to submit to Medicaid and the claim gets paid. But therein is the rub.
As we all know, a GY modifier indicates that the code is categorically non-covered. GA with an ABN which is not recognized by Medicare as appropriate billing for these codes. You'd think that would be enough, but we continue to battle to get paid for these claims where MA is primary.
The battle involves having numerous time-consuming calls with offshore reps who know absolutely nothing. There is no ability to speak with an account rep or in the case of Humana Gold, you can't even speak with an onshore rep. They make lovely promises to help which yields zero results and claims end up being so old that Mainecare will deem them as untimely filing if indeed we ever get that far.
My question is, who does one complain to in order to bring this problem into the light? We work so hard and get so little, it is beyond frustrating to end up in this vortex where nothing gets resolved.
I appreciate any input provided!
Thanks so much,
Elizabeth
Elizabeth A.M. Park, Operations Manager
Sound Limbs Orthotics & Prosthetics
39 South Lisbon Road
Lewiston, ME 04240
soundlimbs.com< <URL Redacted> >
work - 207-784-4345 ext 207
fax - 207-783-9496
As always, I am sure that we are all probably experiencing the same issues with MA plans. I am just wondering if any of you have figured out how to deal with this one.
We do a fair amount of custom foot orthotics and as you all know, Medicare doesn't cover them. However, many Maine Medicaid (Mainecare) plans do. In this scenario, if someone has any sort of Medicare plan as primary, all we need is an appropriate denial code (PR) to submit to Medicaid and the claim gets paid. But therein is the rub.
As we all know, a GY modifier indicates that the code is categorically non-covered. GA with an ABN which is not recognized by Medicare as appropriate billing for these codes. You'd think that would be enough, but we continue to battle to get paid for these claims where MA is primary.
The battle involves having numerous time-consuming calls with offshore reps who know absolutely nothing. There is no ability to speak with an account rep or in the case of Humana Gold, you can't even speak with an onshore rep. They make lovely promises to help which yields zero results and claims end up being so old that Mainecare will deem them as untimely filing if indeed we ever get that far.
My question is, who does one complain to in order to bring this problem into the light? We work so hard and get so little, it is beyond frustrating to end up in this vortex where nothing gets resolved.
I appreciate any input provided!
Thanks so much,
Elizabeth
Elizabeth A.M. Park, Operations Manager
Sound Limbs Orthotics & Prosthetics
39 South Lisbon Road
Lewiston, ME 04240
soundlimbs.com< <URL Redacted> >
work - 207-784-4345 ext 207
fax - 207-783-9496
Citation
Elizabeth Park, “Medicare Advantage Claims Problems,” Digital Resource Foundation for Orthotics and Prosthetics, accessed April 29, 2024, https://library.drfop.org/items/show/255907.
