Saturday, November 26, 2022

Medicare Billing

Jim DeWees

I am just curious if anyone else is having issues with Region B (Indiana) with National Government Services. Recently I was informed that Medicare (NGS) wanted almost $2000 returned to them due to an error and “overpayment” for a claim for a prosthetic leg.

This patient came to my office for a new BK prosthesis, but at the time was in a Skilled Nursing Facility to recover from another medical issue.

There were 2 pages of codes for the limb, and both were paid as normal. The date of service was in April 2011. Then in July 2011 Medicare decided that they wanted the money back for just ONE of the pages, saying that they don’t pay for these codes during a SNF stay. (The other page was not a problem, they paid those codes).

This was according to the “coordinated nursing home billing”. BUT, after speaking with 3 different people at Medicare (NGS….which is Anthem Blue Cross Blue Shield/Wellpoint just to make it clear who is really behind the Medicare billing system…check on www.ngsmedicare.com and see what all NGS is over, and realize how Anthem/Wellpoint is really becoming the “single payer system” that so many politicians really want to end up with…?????).

Back to the point….all 3 of the people I spoke with admit that this is THEIR error, and that these codes ARE payable and not subject to this coordinated billing….They don’t know how these codes were kicked out, BUT I still have to file an appeal with Anthem…OOPS, I mean “National Government Services”, and that will take up to 60 days to reverse this recovery process.

In the meantime, Medicare now is holding the payments to me as an “offset” while they do this appeal.

I have gotten 2 phone calls about this money, and the caller ID shows up as Anthem when they call me….hmmm….

I called today, and she told me that she can see where it is pending, and that it states “pending reversal”, meaning that they have decided that it is THEIR error, and they seem to be just killing time now for 60 days to let me know of this reversal and give me that $2000 back.

This is outright FRAUD on the part of NGS/Anthem against us providers. We are doing work, in good faith, under their rules and guidelines, with an expectation of getting paid the appropriate amount, in a timely manner. And, when they are doing these little tricks like this, to get money back, and make us do MORE work just to get paid the fair amount, this is fraud in my opinion. It is unethical to say the very least.

Is anyone else experiencing this kind of behavior or “errors”?? Is anyone interetsed in joining some coalition to let politicians know what their contracted payer/administrators are doing? I don’t know what good that might do, but I would love to get on national news, MSNBC (yes, I would even stoop to that level so that a few dozen people would see me), CNN (so that a few hundred might see me), or Fox news and just let the public know and realize that our government doesn’t even process any Medicare claims…it is outsourced to and Anthem/Wellpoint company. And, also let other providers know that we ALL are having some kind of issues getting paid for our work. Maybe something like going public would raise awareness which is desperately needed.

Anyway, if anyone is having issues like this, please let me know and see if we can file a joint complaint with the OIG which would be more effective than just a single complaint of one small person going up against a giant like Anthem, who controls Region B medicare, and other regions which are listed on their website that I included here.

I will not re-post the comments or emails that I receive…I will keep them totally private as usual.

Thanks everyone,

Jim DeWees, CP

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