Know how to get Medicare denials

[Guest guest]

For U.S. Practitioners:

Has anyone figured out how to submit AP (acupuncture) claims to Medicare

explicitly for rejections to send to secondary insurance? So far I've

had no luck, except when patients have sent in their own claims for

denial or when I have called the secondary insurer to plead that I'm not

a Medicare provider and Medicare doesn't cover AP anyway (some will

manually reprocess the claims without a Medicare paysheet). Since I'm

not an MD, I can't figure out how to get past the Medicare requirement

that I have a provider PIN to get claims to them. Anyone know?

Thanks.

Ben Hawes, L.Ac.

 

 

 

[Guest guest]

Chinese Medicine , " Benjamin Hawes,

L.Ac. " <bhawes wrote:

>

> For U.S. Practitioners:

> Has anyone figured out how to submit AP (acupuncture) claims to

Medicare

> explicitly for rejections to send to secondary insurance? So far I've

> had no luck, except when patients have sent in their own claims for

> denial or when I have called the secondary insurer to plead that I'm

not

> a Medicare provider and Medicare doesn't cover AP anyway (some will

> manually reprocess the claims without a Medicare paysheet). Since I'm

> not an MD, I can't figure out how to get past the Medicare requirement

> that I have a provider PIN to get claims to them. Anyone know?

> Thanks.

> Ben Hawes, L.Ac.

 

My experience is that without being a Medicare provider they will always

ignore you. We have never been able to receive a denial for the same

reason. What I have done to get around it is go to the Medicare manual

and copy the page that says acupuncture is not covered and send it in

initially (although this is difficult if you do electronic submissions)

or send it when they ask for a Medicare denial with a cover letter.

Misha

[Guest guest]

Regarding medicare denials, I have submitted many times with no effect. Then I

went to a billing company, they submitted for denial successfully. I go to them

now whenever I have to deal with Medicare, it isn't worth the aggravation for me

to do it.

 

?????????????? Beata

 

 

 

[Guest guest]

Thanks Misha. I've done that before with the Medicare info. It works

with some smaller insurers, but United and BCBS are being literal about

it and I'm caught in a Kafka tale trying to get something denied by

people who deny that I can get a denial in order to prove I can legally

be paid...

I really, really hate our healthcare system. " Best in the world " - yeah,

right.

-Ben Hawes

 

 

Re: Know how to get Medicare denials

<Chinese Medicine/message/28579;_ylc=X\

3oDMTJyb3Fjc3BnBF9TAzk3MzU5NzE1BGdycElkAzk0OTU5NzcEZ3Jwc3BJZAMxNzA1MDYwODE0BG1zZ\

0lkAzI4NTc5BHNlYwNkbXNnBHNsawN2bXNnBHN0aW1lAzEyMDQ3MDY5NTk->

 

 

 

Posted by: " Misha Cohen " TCMPaths

<TCMPaths?Subject=%20Re%3A%20Know%20how%20to%20get%20Medicare%20d\

enials>

chinmedsf <http://profiles./chinmedsf>

 

 

Tue Mar 4, 2008 8:21 am (PST)

 

 

Chinese Medicine

<Chinese Medicine%40>, " Benjamin

Hawes,

L.Ac. " <bhawes wrote:

>

> For U.S. Practitioners:

> Has anyone figured out how to submit AP (acupuncture) claims to

Medicare

> explicitly for rejections to send to secondary insurance? So far I've

> had no luck, except when patients have sent in their own claims for

> denial or when I have called the secondary insurer to plead that I'm

not

> a Medicare provider and Medicare doesn't cover AP anyway (some will

> manually reprocess the claims without a Medicare paysheet). Since I'm

> not an MD, I can't figure out how to get past the Medicare

requirement

> that I have a provider PIN to get claims to them. Anyone know?

> Thanks.

> Ben Hawes, L.Ac.

 

My experience is that without being a Medicare provider they will always

ignore you. We have never been able to receive a denial for the same

reason. What I have done to get around it is go to the Medicare manual

and copy the page that says acupuncture is not covered and send it in

initially (although this is difficult if you do electronic submissions)

or send it when they ask for a Medicare denial with a cover letter.

Misha

 

 

 

 

[Guest guest]

Chinese Medicine , " Benjamin Hawes,

L.Ac. " <bhawes wrote:

>

> For U.S. Practitioners:

> Has anyone figured out how to submit AP (acupuncture) claims to

Medicare

> explicitly for rejections to send to secondary insurance? So far

I've

> had no luck, except when patients have sent in their own claims for

> denial or when I have called the secondary insurer to plead that

I'm not

> a Medicare provider and Medicare doesn't cover AP anyway (some will

> manually reprocess the claims without a Medicare paysheet). Since

I'm

> not an MD, I can't figure out how to get past the Medicare

requirement

> that I have a provider PIN to get claims to them. Anyone know?

> Thanks.

> Ben Hawes, L.Ac.

>

>

 

 

I have done this process a couple of times...I send a letter to

Medicare with the patient's health insurance claim number, dob, and

their Medicare number. In the letter I just tell them that I am in

need of a letter from them stating that " Medicare does not cover or

pay for acupuncture services... " They then have sent me back a

letter stating such and initially, when I bill, I submit a copy of

that letter to the second party insurance company as verification.

This process does take a few weeks so just be aware of that.

 

Write to:

 

Nordian Administrative Services, LLC

A CMS Contracted Carrier

901 40th Street S, Suite 1

Fargo, ND 58103-2146

 

(CMS= " Centers for Medicare & Medicaid Services).

 

Good Luck!

 

Rachel Diaz

 

>

[Guest guest]

Hi Benjamine: Yes, include their second party insurance number and

name. BUT, be sure first, that their second party does include

coverage for acupuncture.

So, for instance, I might say:

" My patient, John Smith " has a secondary insurance of Blue Cross/Blue

Shield. His policy covers acupuncture services but first I must submit

verification that Medicare does not cover acupuncture services.

His Medicare number is: 000-00-0000

DOB is: March 4, 1956

Blue Cross number: ZLA 234-56-7890

Thank you, blah blah blah "

 

I hope this helps!

 

Rachel Diaz