I’m looking for guidance concerning Medicare dually patients, in this case
it is a First Choice VIP dual enrollment plan. I have been providing for
this patient for over 10 years and never had any problems. Now I bill for
diabetic shoes and only get paid $152 out of the allowed $254. After calling
First Choice I was told it was reduced because she had a deductible and/or
co-pay (even though the EOB doesn’t state either). So I billed the patient
only to get a call back from First Choice stating I couldn’t bill the
patient because she was on a QMB plan.
https://urldefense.proofpoint.com/v2/url?u=https-3A__www.cms.gov_Outreach-2Dand-2DEducation_Medicare-2DLearning-2DNetwork-2DMLN_MLN&d=DwICAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=UU3sC97GdYKW2KarOzTZFYaY-AKE8l_878vOKntiW2Q&s=AzL5ag_B_3JoDfKyz20kHqoTt_dLfgmY3drFbPFAImI&e=
MattersArticles/Downloads/SE1128.pdf
First Choice was unable to answer these questions.
Since they claim she had a roughly $100 deductible, if the claim had only
been $100 then would I get absolutely nothing for providing for the patient?
Is this her Medicare deductible or is it a First Choice deductible? And if
it’s a First Choice deductible what is preventing them from saying the
patient has a $5000 deductible and then not pay providers at all.
How is it that a provider is responsible to Donate to patients? We pay money
to get/make the items we furnish, yet we can’t get paid.
Medicare states some Medicaid plans MAY cover the difference, however; since
their EOB doesn’t state it was a deductible or co-insurance it was denied.
Is there any way to collect on these claims?
Thanks in Advance.
Jeremy Sprouse CPO
