Try contacting your state insurance commissioner. This link has information on how you as a health care provider can file a complaint. http://www.ncdoi.com/Consumer/consumer_providers.asp

In fact, in todays health care climate, it might be a good idea that any time we run up against this, we file complaints.

Keep us posted.

Barbara

What can we do in effort to keep our patients when we accept medicare. In Virginia, medicare patients eventually are changed to a PPO. This poses a problem. The PPO’s here will not credential NP’s. Catch 22 or what? There must be something I can do.

The only insurance thus far that has agreed to credential me as an NP is Medicare, Medicaid and Tricare.

Any suggestions. I do plan to offer flat fee. But really need a suggestion on how to get credentialed. Does anyone have a good template for a reconcideration letter?

Thanks,
Cecelia
clrk4@aol.com

Yes, if you see a patient on a certain date that your practice is open, and Medicare makes your contract retroactive to that date, then even if it was 4 months prior, you can submit your claim and they will pay it. Just remember that Medicare does not pay for preventative codes like 99386 etc, unless they are brand new to Medicare and it is part of their “Welcome to Medicare” benefit. I made this mistake, for an “annual exam” for a 72 yr old female who transferred care to me, and I had just opened, and spent an hour with this patient, and Medicare paid zero. I should have charged a 99204 as an office visit, as she did have health concerns. Just look up all of the coding exceptions, for screening as well. Carla

For Oregon,

I filled out an 855i
460
588
and an electronic filing agreement with a letter from the bank. I called 7 customer service agents and got seven different answers about areas on the form, because I was previously credentialed as an employee for someone else before, and now I am filing as a different business entity. But you are right. You have to give your personal npi, your clinic npi, your clinic tax id number, and then eventually I should get a Medicare number for myself, a separate one for the clinic that will attach to my clinic tax id for billing, and then if I work for another provider, which I am doing, I will have to fill out an 855b to have a different Medicare billing number attached to that organization. It does seem as if you should have just one NPI that attaches to the different tax id numbers of all of the different places you work, but they still have it more complicated. I also was able to find a site that I paid 20.00 for, but it allowed the documents to be re saved, and typed on line, instead of printed and hand written. When you try to type on the original Medicare Noridian Website application, things get deleted, and it does not work well at all. With that one you just have to print it off and hand write it.

I notice you said you filled out an 855b? I was told repeatedly that I had to fill out an 855i as a nurse practitioner, that was starting a “new business entity”, so I had to fill out the “individual form”… I will call Monday now that I am getting a chance to catch up on the insurances, and see what the status is.

You can find the standardized forms for WA State in both word and pdf at http://www.wamss.org/02Tools.html.

Download a copy and add your information. You can print out the entire thing each time you have an application you are sending in. You’ll just need to sign it after filling out the attestation page (which you sign as well). The word doc form is about 13 pages.

Hope this helps.

Barbara

I finally have my paperwork in front of me. It seems like eons ago since I did this. I filled out the following:
1. CMS 885B
2. CMS 460 (Participating Agreement)
3. CMS 588

You are correct…I had to have one for my LLC and on for myself (group and individual).

If you want to file electronically directly to CMS, you need a EDI Enrollment Form among other things. Since I am using Office Ally, I didn’t need to do that.

Something we recently learned, is there is something called Medicare/Medicaid crossover. Medicare will tell you they are sending the bills to Medicaid, but unless you actually sign up for that…it does not happen. I’ve asked her to write more about that for us…so stay tuned.

Barbara