Wiki Medicare nightmare! 4 clinics 3 years of payments held.

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lazuanda

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Hello,

We have 7 clinics in the Dallas Ft. Worth area...all of them in practice and enrolled in medicare for over 10 years. When I left the clinics to work elsewhere in 2003 all clinic groups were active in Medicare and getting paid. I have returned in 2010 to find that 4 of the clinics have not been paid by medicare since 2006. The reasons vary but it appears that the problems mostly started when the clinics went from paper claims to electronic. Medicare has processed a lot of the claims with payments marked as "do not forward" and we can't get the payments released. Then we have many claims they never processed because of deactivation of group numbers etc.

Anyway, we are looking for someone who can represent us with Medicare to try and get an audience with them to get the old claims accepted, checks they are holding released, and group numbers reactivated. It would be ideal to be able to sit down with them in person and sort it out. Trying to go through the provider relations hot line gets us a different answer / instructions every time.

You would be working directly with me on this project and MUST HAVE SUCCESSFUL EXPERIENCE WITH THIS TYPE OF BATTLE. It does not matter if you are an attorney, professional biller, outside concultant as long as you can provide results.
 
hello, my name is Shannon and I was in the same battle for one of my clients-it took 9 months to figure out however it was done and he is being paid as he should.
The same problem from paper to electronic- you need to make sure your numbers are matching when they go to medicare crossover! If your numbers are not activated what will happen is they will give you all new numbers but you must do all the applications over again.
If you want my help please contact me at smsullivan@atlanticabc.com. I am not able to work with you in person but remotely can be done.
 
If you are still having difficulties I would be willing to assist. The facility I work at now had hired a outside agency to do their Medicare billing. Unfortunately, this billing had no experience with a CAH or RHC. The billing was a nigthmare. I was able to get it cleaned up in a few months and have everything working smoothly now. My email is sam_thompson25@hotmail.com.
 
I came across your post and I was wondering if you every got this cleaned up. My big question to you is why would everything get so mess up going from paper charts to electronic charts? Is is because they changed their PM system? If not, I cant imagine why this would happen. I have ciients in TX that I am working with and trying in the beginning to get a hold of TrailBlazers was a HUGE NIGHTMARE! The shouldn't even be allowed to process Medicare claims, they are absolutely horrible!! If you have time to reply plz send to my email at custommed@cableone.net. I am wishing you well! I feel your pain.
 
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