Post Reply 
Learned a hard lesson
Author Message
GrammaBear Offline

Advisory Members

Posts: 381
Joined: May 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #21
RE: Learned a hard lesson
(10-13-2015 01:38 PM)justMongo Wrote:  
(10-13-2015 11:39 AM)Homerec130 Wrote:  ...just changed over to a new coding system on Oct 1st. I went to get some bloodwork done and they refused it saying I had the old diagnosis codes on the form (even though they were correct when it was printed).

I just love paperwork.

Oct 1st, Medicare switched to ICD-10 codes. Which means many bills will be coded incorrectly for months.

Oh great.....just what I don't need. Medicare seems to be a real challenge anyway you look at it.

I have to pick up another form at the GPs office tomorrow and maybe this one will help Medicare get it right.
10-13-2015 04:31 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
OpalRose Offline

Monitors

Posts: 3,180
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #22
RE: Learned a hard lesson
I've had a few bills denied by Medicare lately. Always the same answer from Medicare, denied due to a billing code error.

The thing is, the doctor, lab, hospital or whoever made the error is not allowed to charge you.
They must correct the error and resubmit. So don't pay that Ambulance bill if you think that it might be due to a coding error.

OpalRose
10-13-2015 05:00 PM
Find all posts by this user Post Reply Quote this message in a reply
surferdude2 Offline

Advisory Members

Posts: 1,077
Joined: Jul 2014

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro & Optilife
Humidifier: ResMed H5i @ #3 if nose breathing & #5 if mouth breathing
CPAP Pressure: 12 ~ 20 & 11 ~12 if nasal mask
CPAP Software: ResScan SleepyHead

Other Comments: Late stage 2 emphysema

Sex: Male
Location: Mousetown, Southern Illinois

Post: #23
RE: Learned a hard lesson
(10-13-2015 04:31 PM)GrammaBear Wrote:  I have to pick up another form at the GPs office tomorrow and maybe this one will help Medicare get it right.

I can't imagine what kind of form the GP could give you that would settle this matter. He needs to be giving information to Medicare and the ambulance company rather than directly to you. It's not your responsibility to deal with Medicare directly, it's the responsibility of the providers.

Dude
10-13-2015 05:47 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
GrammaBear Offline

Advisory Members

Posts: 381
Joined: May 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #24
RE: Learned a hard lesson
(10-13-2015 05:47 PM)surferdude2 Wrote:  
(10-13-2015 04:31 PM)GrammaBear Wrote:  I have to pick up another form at the GPs office tomorrow and maybe this one will help Medicare get it right.

I can't imagine what kind of form the GP could give you that would settle this matter. He needs to be giving information to Medicare and the ambulance company rather than directly to you. It's not your responsibility to deal with Medicare directly, it's the responsibility of the providers.

Dude

The form I will pick up is the one the ER doctor had to fill out that said it was "medically necessary" to call the ambulance. I realize it is the provider's responsibility but the bill from the ambulance service wasn't addressed to the provider and it won't be her credit rating that suffers, it will be mine.
10-13-2015 07:55 PM
Find all posts by this user Post Reply Quote this message in a reply
Homerec130 Offline

Advisory Members

Posts: 445
Joined: Mar 2012

Machine: Philips/Resperonics BiPAP auto SV Advanced System One (950P)
Mask Type: Full face mask
Mask Make & Model: ResMed Quatro FX
Humidifier: Philips Respironics System 1
CPAP Pressure: 6-16
CPAP Software: SleepyHead

Other Comments: But it is a dry heat.

Sex: Male
Location: Tucson, AZ

Post: #25
RE: Learned a hard lesson
(10-13-2015 01:38 PM)justMongo Wrote:  
(10-13-2015 11:39 AM)Homerec130 Wrote:  ...just changed over to a new coding system on Oct 1st. I went to get some bloodwork done and they refused it saying I had the old diagnosis codes on the form (even though they were correct when it was printed).

I just love paperwork.

Oct 1st, Medicare switched to ICD-10 codes. Which means many bills will be coded incorrectly for months.

Actually, it is industry wide and not just Medicare. I am on TriCare (bastard brother/sister of Medicare) and their codes have changed. One good thing about my insurance, if a doc takes Medicare, by law they have to accept TriCare standard. BTW, still haven't heard back from my doctor's office in the correct codes. That will be tomorrow's phone call.

Homer
10-15-2015 01:53 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #26
RE: Learned a hard lesson
(10-13-2015 07:55 PM)GrammaBear Wrote:  I realize it is the provider's responsibility but the bill from the ambulance service wasn't addressed to the provider and it won't be her credit rating that suffers, it will be mine.

GrammaBear,
The provider of the service is the ambulance service. They are billing you. Have you spoken to them directly? I would think that they would submit your info. (incl. drs. note if needed) to Medicare so they can get paid by Medicare.
Are they listed as the provider of service on the Medicare Explanation of Benefits on which the service was denied?
10-15-2015 02:44 PM
Find all posts by this user Post Reply Quote this message in a reply
GrammaBear Offline

Advisory Members

Posts: 381
Joined: May 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #27
RE: Learned a hard lesson
(10-15-2015 02:44 PM)regbeach Wrote:  
(10-13-2015 07:55 PM)GrammaBear Wrote:  I realize it is the provider's responsibility but the bill from the ambulance service wasn't addressed to the provider and it won't be her credit rating that suffers, it will be mine.

GrammaBear,
The provider of the service is the ambulance service. They are billing you. Have you spoken to them directly? I would think that they would submit your info. (incl. drs. note if needed) to Medicare so they can get paid by Medicare.
Are they listed as the provider of service on the Medicare Explanation of Benefits on which the service was denied?

Sigh........I have not spoken with the ambulance service directly. Just today I got a copy of the order signed by my doctor to "admit" me to the hospital. The facility where I saw the ER doctor hasn't got any 'inpatient beds', so the ambulance service was called to transport me to a nearby hospital that would accept me as an inpatient. I also printed a copy of the claim that was denied by Medicare and the ambulance service is listed as the 'provider'. Sometimes it is most difficult for me to talk on the phone, depending on the voice of the person to whom I'm speaking, because I am seriously hearing impaired. Sad
10-15-2015 06:48 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
regbeach Offline

Preferred Members

Posts: 21
Joined: Oct 2015

Machine: Philips BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: Amara View or F10
Humidifier: Philips System One
CPAP Pressure: 9-18 IPAP, 6-12 EPAP
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location:

Post: #28
RE: Learned a hard lesson
GrammaBear,
Hopefully, you or your husband will be able to hear the person on the phone at the ambulance service so you can resolve it quickly. Or perhaps you could get their fax number and send them the details of your request and supporting documents. Then, you could write it out and not have to worry about an extended phone conversation.
Good luck.
10-16-2015 12:06 AM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  so hard to get a good coffee Paptillian 38 5,691 05-24-2015 08:40 PM
Last Post: 2PAPs

Forum Jump:

Who's Online (Complete List)