Medicare finally billed

Pacer Checks Billing

by Marybird - 2022-08-10 15:27:54

Well, I guess that will teach your clinic's billing department not to hold onto those bills and not send them past the date that Medicare will accept them.

What happens now? Who pays?

by Gemita - 2022-08-10 16:17:20

New to Pace, can you please tell me more.  What happens now?  Were the bills for the remote transmissions and stress test unusually high or just plain “late” for Medicare to process?  Would be interested to know what each remote transmission costs + the cost of the stress test. 

Medicare charged

by new to pace.... - 2022-08-10 17:57:52

You are right Marybird.

Gemita they submitted  late as they were  all on the July  2022 statement from Medicare,. for claims processed between April 29-July 2022

    The remote charge up to 90 days to medicare was $72. and the same without the 90 days charge was $67. For the June 15,2021 charge medicare wrote "the time limit for filing your claim has expired therefore appeal rights are not applicable for this claim."

The stress test on July 22.2021 total cost was $1927.  the breakdown is below " the Exercise or drug-induced heart stress test with electrocardiogram(ECG) with supervision and review was $182. Medicare's comments are They cannot pay for this service for the diagnosis shown on the claim. The information provided does not suport the need for the service or item.  Also  since I did not know this service isn't covered , i do not have to pay.' "Future services of this type won't be paid".

  The nuclear medicine studies of heart muscle at rest and with stress and SPECT($861) Medicare said this is a duplicate of a charge already submitted.   Injection, regadenoson $412. again a duplicate of charge already submitted.   Technetium tc-99m sestamibi, diagnostic, per study dose $472, again a duplicate charge.

Dec 2021 & March 2022 evaluation of single, dual, multiple lead or leadless pacemaker system,  remote up to 90 days(code 93294) charge of $72 .was charged to Medicare from the Heart Specialist. Medicare approved $30.80. Paid to provider $25.03 the balance of the approved my medgap  policy will pay $6.16.  Evaluation of single, dual , multiple or leadless pacemaker system or implantable defibrillator( code 93296). charged$ 67., approved $24.42 paid $19.85 sent to medigap $4.88 .

  What is interesting is the description as it relates to all  systems not mine in particular.

 Have the yearly  in office  on  Aug.22,2022. Will be interested in seeing when that one gets billed or not. Or if Medicare excepts this one.

 new to pace

Medicare

by AgentX86 - 2022-08-10 18:28:01

I've had some odd ones, too, but they're not my problem.  My cardiologist (actually a major hospital) billed twice for a couple of appointments so they get nothing.  They may be able to clear it up by rebilling properly but it's not my problem.  I just got the bill for my PET scan.  $11,000 and some change.  Medicare said that I "may be responsible" (I won't be) for $650, or something.  That means the medicare discounted bill was $3200, or about 30% of "retail".  My private insurance was discounted 50-60%, so it makes sense.  For thouse outside the US, the really high prices you hear about are a fiction (used to support large write-downs of uncollecable uninsured claims). No one actually pays that amount.

billing

by new to pace.... - 2022-08-10 19:04:11

What AgentX86 said about the high price it is a write off for them.

new to pace

Write off

by AgentX86 - 2022-08-10 22:53:49

Hospitals, and other health care facilities have the phony prices, then negotiate the real price with each insurance company. They'll negotiate with individuals for cash money, too, though pricing is opaque (that's supposed to be fixed but they're dragging their heels).   Medicare/Medicaid tells them what they're going to pay, take it or leave it.  If they choose to leave it, they can't take *any* government payment for anyone for anything.  Take it, all or nothing.

The full phony price isn't exactly a write-off.  They can only write off what is actually spent on uncollectable care, not the phony "retail" price. 

Hospitals have a "slush fund" they use to pay for indigent patients and uncollectible bills.  This is used to show the community all of the "good" they're doing, try to get public funding to pay some of this, or when they want special treatment (zoning changes, building permits, etc.).  They use this phony number as their justification.

Drugs are a completely different slimy kettle of fish.

Nuclear Stress Test Cost

by benedeni - 2022-08-11 15:09:46

Just to add, today I got a Summary Notice from Medicare.  There is a nuclear stress test included and the charged total amount was $2,578.00  $568 of this was for the injection of nuclear medicine I'm assuming.  (Injection, regadenoson, 0.1 mg.)  Says I may be billed $161.24 which I don't worry about because my supplemental will pick that up. 

Remote Monitoring Bills and Medicare

by Marybird - 2022-08-11 23:32:01

It looks like my cardiologist's office is pretty punctual in their billing, and they seem to bill close to the amount that they know Medicare will pay. They use a monitoring company ( Cardionet) to collect, read and interpret remote cardiac device reports, and the company sends a completed report to the cardiologist/pacer technician. In this case the company bills for the technical component of the report and the office bills for the professional component for review and  clinical correlation and decisions as needed. I see, the company bills,Medicare around $270 for the technical component of the remote monitoring,, but Medicare pays them around $27.00 for that. The cardiologist's,office bills about $30.00 for the professional component,,and Medicare pays them around $27 and change., I haven't seen that the monitoring company bills Medicare for my monitor reports every 3 months, I've only seen one this year, but the cardiologist's office keeps up,with every one. 

As I understand it, in the event of a billing error or problem resulting in a Medicare denial of payment ( unless they deny it because,they don't consider it a "covered service") a patient can't be held responsible for the bill,not pa8d by Medicare. For a patient to be responsible for a bill denied by Medicare, the patient must be informed beforehand that Medicare may deny the service,,and,sign an "Advanced Beneficiary Notice" (ABN) stating he/she will be responsible for payment if Medicare doesn't pay. The amount the patient would be expected to pay must be listed on the form. I've been asked to,sign ABNs,for the optic nerve scans and peripheral vision checks they do once a year as monitoring my glaucoma, as they tell me Medicare may not pay those. In my case,with a glaucoma diagnosis, they always have paid.

Generally,,the quarterly reports showing,what Medicare paid for a,patients medical services will include in the amount that may be owed by a patient just the 20% of the amount Medicare allowed not paid by them. 

I think I have a better understanding now!

by Gemita - 2022-08-12 06:52:02

New to Pace and everyone, I am very grateful for all this information.  It does look to be a most complex system perhaps in need of an overhaul.  I am sure your government has it in hand but a different subject altogether I know. 

I am not sure that I would want Medicare documents to come through my letterbox requiring my attention, even if the health authorities/hospitals are largely responsible for the billing and Medicare for payments.  As the patient I would still feel responsible for clarifying any discrepancies and this would just add another level of anxiety and work to my already heavy workload.

I guess we are still fortunate to have a national health service in the UK with all its faults, although clearly we cannot get treatment quickly unless we choose private medical care. 

billing

by new to pace.... - 2022-08-12 06:56:43

Marybird you are right.  The  20% that Medicare does not pay is paid by my Medigap policy.

I to have signed that form about Medicare may not pay for this. Now thinking might not sign that paper at the Heart Center.   Last time i was at the blood lab signed that form and it had the prices on it.  Know that Medicare may not pay for the Sed rate test, as have paid for it myself the previoust  time, will see if get a bill for this time.  Now will not sign that paper when in my regular lab.  Lap Corp charges are high  the last time they wanted me to pay $500. for the tests.  Contacted my accupuncturist and was able to pay  to her $130.  quite a difference.

new to pace

Medicare 20%

by AgentX86 - 2022-08-13 12:20:35

Just to clarify for those not in the US.  If Medicare pays $.01 of the bill this "Medigap" or "Supplimental Medicare Insurance", a private but controlled insurance on top of Medicare, must pay the remainder. There are something like seven different plans but all are controlled by Medicare. Insurance coverage or denial isn't up to the insurance company. If Medicare rejects the coverage completely, you pay everything.

This Medigap insurance isn't cheap, I pay around $3000 per year for both my wife and I but that covers 100% of everything, after a $230 deductible (Medicare, not Medigap). I get statements from Medicare but no bills. (Classical) Medicare sounds more complicated than it really is.  It is written by congresscritters and while the rules are opaque and often stupid, they're written by opaque and stupid people.  Go figure.

Sed rate tests are paid but only for some restricted diagnostic uses, primarily autoimmune diseases. There are labs that cost 1/3 what the hospital labs cost.  Which isn't surprising because hospitals charge insurance companies 1/3 of the "listed" costs. 

BTW, if you don't sign that you'll pay if your insurance doesn't, you most likely won't get the treatment.  Worse, they won't tell you and probably won't get pre-authorization if it's required. This isnt' so important for classical Medicare (what we've been talking about here) but the Medicare Part-C (a.k.a. "Advantage" plans) and many private insurance plans  are quite dangerous this way. Step carefully.  There are no guardrails here and it's a long way down. Avoid this insurance if at all possible.