A sad day for patients

Friday, October 25, 2013

Since 2013, we have been experiencing difficulty in getting power wheelchairs approved by Medicare. A doctor drawing a “single line” not a “double line” through a correction is one example as to why we got a denial. My jaw dropped. 

I now have a patient who we finally got approved after several attempts since February 2013. Corrections to the paperwork (the usual) for the pre-approval from Noridian was sent to us on April 4.

The power wheelchair was delivered mid-April, only to be denied by Medicare on May 5, claiming the beneficiary was not Medicare primary.

We always use the Noridian website to verify insurance eligibility as required per Medicare, check same-and-similar, etc. The patient clearly showed Medicare primary.

I called Medicare to dispute the claim and asked for a reopening over the telephone, and my billing company told me to just resubmit it as a new claim.

After a failed attempt to resubmit a new claim, they informed me and my billing company in August that they no longer did reopenings and that it would have to be a redetermination, even though the billing error was admitted to be on their end. Redeterminations can take up to another three months.

I was also told by my billing company after going around and around that the redetermination submission deadline was Aug. 17.

I do not understand how, if it is their error, the patient is Medicare primary, they already determined the patient qualifies for the power wheelchair because we have the pre-approval, they admitted it was their system that “needed to be updated,” yet, I have to submit all the paperwork again.

This is getting beyond ridiculous, not to mention that we are about to go into an eight-month period of not getting paid for services provided.

How does Medicare expect its providers to survive on such ridiculous procedures?

It’s almost like they do not want to pay for anything even though you have the proper paperwork. The delays in payment, “updates” to the system and numerous billing errors on their end are very discouraging.

The system is failing not only the providers, but also the community.

It’s a very sad day for healthcare patients, and frustrating for them.

Something has to be done, and fast.

—Teresa Austin, manager, American Mobility Center (Medical Supply)