Wiki Provider not active with Medicare

[Aochoa3]

Our np is currently not active with Medicare due to some issues during the re validation process. Every time we see a Medicare patient we do not get paid for and have to write it off. Therefore we stopped scheduling them with that particular provider. We have Medicare patients who refuse to see anyone else and insist to be seen by her. Can we charge them as self pay if they agree to pay the full consultation?



-Karen

 

[1formissy]

You can bill Medicare for patient's that see the NP as long as you have a billing provider with a current PTAN. You will have to make sure the NP get's reimbursed for the service they render and that can be tracked on your billing software.

I would also get the PTAN resolved with Medicare in regards to your NP and ask them to retro-back that PTAN's effective date.

In my previous employ, I had a similiar situation from someone who was previously in charge of the Medicare AR who was no longer there, so they hired me. The PTAN's were all dated wrong, and I was able to get the PTAN's retro dated back several months, and then I rebilled all the claims which were paid.

 

[kenkie79]

Yeah, you have to contact Medicare and get that fixed. We had that problem with TWO of our physicians. We had to start the whole process over but we got everything retro. Their validation process is so long and confusing that it can take months to get things corrected. To those that refuse, shouldn't they sign an ABN and let their secondary insurance take care of it though?

 

[1formissy]

No, you cannot have a patient sign an ABN and then bill their secondary insurance. The secondary will not pick up anything that Medicare has denied, and since this is a contracting issue, and not that of an eligibility issue, the beneficiary is not resposnible for the charges.

Those claims should remain on hold until you can get the provider's PTAN active, with a retro-date, then re file those claims to Medicare.