Wiki Help w/medicare

[PLAIDMAN]

I am so confused....Medicare is telling me that they pay by PTAN location.....they tell me they look at box 32 on claim which has the location of servies rendered.

I know that they DO NOT look at this...because we have been billing medicare for YEARS with a certain location, a location that medicare is telling me was deleted from their records back in 2006.

So how could this location have been deleted in 2006 - which we HAVE been billing for since before and after 2006 - AND we have been billing with this address ??

Can anyone make sense of this for me? How does Medicare not know about a location that we have been reporting with for years?

AND what is the point of aquiring the PTAN's if medicare does not even look at POS on claim?

PLEASE HELP

 

[lbennett@azaleahealth.com]

I'm not sure the person you talked to at Medicare knew what they were talking about. Medicare looks at the billing provider information in box 33 of the HCFA form, the tax ID, and the PTAN they have on file. The billing provider info in box 33 consists of the billing provider name, address, and NPI. This could be different than the service facility name, address, and NPI in box 32 and different from the rendering provider NPI in box 24J. Keep in mind, I know that Medicare requires electronic claims, but I wanted to reference the paper claim fields for simplicity.

I say all of that to say this, I would call the main provider help line at Medicare and input your NPI, tax ID, and PTAN to verify you have the correct "combo" before calling them back. If you do not know your correct "combo", then call the Medicare provider helpline and ask them for help getting a copy of your Welcome to Medicare letter. This is the letter the practice received when they first became in-network with Medicare.

Once you finally have the correct "combo" you will need to verify with your PM software vendor that the correct tax ID billing provider name, address, and NPI is appearing on the claim (this applies to paper and EDI claims just be on the safe side and in case you need to print paper claims to attach to records/appeals). Then verify the with your clearinghouse that your EDI Enrollment paperwork has been approved with this "combo." All of this should fix your problem and keep you from having to run around in circles with Medicare.

Keep in mind, all of the above information applies to providers who are actively in-network with Medicare. If your group and/or providers are not in-network, then you have bigger problems.