Providers recoup payments

Friday, October 31, 2008

Providers in the first 10 competitive bidding areas are starting to get a little something extra in their Medicare payments-adjustments for claims billed during the first half of July.

CMS kicked off the first round of competitive bidding July 1, but Congress delayed the program for 18 to 24 months on July 15. The payments make up the difference between the competitive bidding and current fee schedules.

“I was hoping they would do it sooner,” said provider Mark Sangree, vice president and general manager of Respicare of South Florida in Deerfield, Fla. “I experienced a significant loss in the form of delayed revenues.”

The big issue now: collecting additional money from secondary insurances and beneficiaries. By law, providers are required to attempt to collect co-pays from beneficiaries, but that’s something they’re often reluctant to do, for fear of driving them away.

Making matters worse, rebilling beneficiaries for something they have already paid for could be confusing, said Sylvia Toscano, owner of Boca Raton, Fla.-based Professional Medical Administrators, which provides HME billing.

“They are going to call up angry and say ‘I already paid this bill, why am I getting another one?’” she said. “Same thing with the supplemental insurance. I expect to see increased denials because the claim for that date of service has already been paid.”

At the end of the day, rebilling may not be worth the time and expense for many providers.

“We are going to do an analysis to see how much it will cost to produce those bills,” said Raul Lopez, operations manager for Bayshore Dura Medical in Miami Lakes, Fla.