Help with Medicare please

[shellip]

Hello all! I have a question regarding Medicare, hoping someone will share wisdom with me. My question is: with the new Medicare change regarding provider enrollment only retro 30 days, what happens with claims that fall during the "non-par" status? (Non-par status being the time provider practicing prior to the date of effective participating status with Medicare). According to the EOMB I received, these claims are all patient responsibility. We were unaware there would be issues during the enrollment process that would cause these claims to be non-par, and we are appealing, but in the meantime......... I guess I wonder: if the claims have accept assignment checked, then shouldn't 'something' other than zeroes process on EOMB? I really appeciate any help offered!! THANKS!

[kbarron]

I don't have an answer to your question, however I have a question. Where does it state that you can only retro 30 days. We are holding MCR claims for a provider because there is a problem that no one can seem to fix.

[LLovett]

Did they cut checks to the patients? There are limiting fees even for non par providers, not sure how they show those on EOBs though, so as long as your fee is less than that I would bill the patient.

All of my providers are in network but my father is a doctor in private practice that does not participate with Medicare. Most of the time they cut checks to the patients directly even though the patients have signed for the checks to go to him. I don't know too much about it though, when I work for him on the rare occasion I just sit there and look pretty, I try not to get too involved.

Not much help but maybe a possibility to check out.

Laura, CPC, CEMC

[RebeccaWoodward*]

Originally Posted by kbarron

I don't have an answer to your question, however I have a question. Where does it state that you can only retro 30 days. We are holding MCR claims for a provider because there is a problem that no one can seem to fix.

The individuals and organizations identified above may, however, retrospectively bill for services when:
•
The supplier has met all program requirements, including state licensure requirements, and
•
The services were provided at the enrolled practice location for up to—
•
30 days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries,


http://www.cms.hhs.gov/MLNMattersArt...ads/MM6310.pdf

[RebeccaWoodward*]

Originally Posted by shellip

Hello all! I have a question regarding Medicare, hoping someone will share wisdom with me. My question is: with the new Medicare change regarding provider enrollment only retro 30 days, what happens with claims that fall during the "non-par" status? (Non-par status being the time provider practicing prior to the date of effective participating status with Medicare). According to the EOMB I received, these claims are all patient responsibility. We were unaware there would be issues during the enrollment process that would cause these claims to be non-par, and we are appealing, but in the meantime......... I guess I wonder: if the claims have accept assignment checked, then shouldn't 'something' other than zeroes process on EOMB? I really appeciate any help offered!! THANKS!

See if the link below answers your questions........

http://www.aafp.org/online/en/home/p...reoptions.html

[Marje]

The Company I work for runs into this problem with Medicare and other insurances when we hire new Physicians and their enrollment with all insurances is not complete when they begin seeing patients. When the insurances deny for non-par or non-credentialled, we usually adjust/write off the charge as a courtesy to the patient b/c it is not the patients fault that the Physician they are seeing is not enrolled with all insurances yet.
Hope this helps!
Marje