Claims from COPD Services (my DME):
Dec/Jan/Feb CPAP device rental
Supplier charged $119/119/119
Medicare approved $93/93/70
Medicare paid $74/75/56
You may be billed $19/19/14
Is it weird that they approved a different amount for Feb, and different pay-backs each month???
Oh -- note D: "Payment is reduced by 25% beginning the 4th month of rental." Really???
Interesting Notice From Medicare
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Interesting Notice From Medicare
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“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; YOU are the one who gets burned.”
“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; YOU are the one who gets burned.”
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SleepWellCPAP
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Re: Interesting Notice From Medicare
This is a very good post regarding reimbursement, as most all insurances follow Medicare guidelines.
The third month reduction you are seeing is more than likely due to competitive bidding currently sweeping the country. The concept saves money for the government; the ultimate cost for which will inevitably be passed along to the patients. In the MCR paid column, you have 80% of the allowable for your device. This rental of course will continue for a total of 13 billing cycles.
The reason I'm chiming in, is to highlight how allowables can change from one month to the next. It is confusing for everyone to say the least. I don't know how many times I've done an equipment set up, collected the required copay, and then had the patient call me back 3 months down the road because they are are looking at a bill from their initial date of service. Usually it's a small amount, but give me a break, if that's what the patient was supposed to pay at that time, make it that amount.
With all due respect to those in the insurance business, it is not easy billing you.
End of venting... regular programming will now resume.
The third month reduction you are seeing is more than likely due to competitive bidding currently sweeping the country. The concept saves money for the government; the ultimate cost for which will inevitably be passed along to the patients. In the MCR paid column, you have 80% of the allowable for your device. This rental of course will continue for a total of 13 billing cycles.
The reason I'm chiming in, is to highlight how allowables can change from one month to the next. It is confusing for everyone to say the least. I don't know how many times I've done an equipment set up, collected the required copay, and then had the patient call me back 3 months down the road because they are are looking at a bill from their initial date of service. Usually it's a small amount, but give me a break, if that's what the patient was supposed to pay at that time, make it that amount.
With all due respect to those in the insurance business, it is not easy billing you.
End of venting... regular programming will now resume.
Jim Swearingen
Author of the book Sleep Well & Feel Great with CPAP, a definitive guide
For a free copy inquire with your local county librarian
CPAPtalk featured - Also available through Barnes & Noble Booksellers
Author of the book Sleep Well & Feel Great with CPAP, a definitive guide
For a free copy inquire with your local county librarian
CPAPtalk featured - Also available through Barnes & Noble Booksellers
Re: Interesting Notice From Medicare
Medicare has for a long time, if not almost always, had a two tier rental reimbursement. The rate is less after 3 months. The $74 vs $75 probably reflects rounding in the billing list you show above, or did you do a typo copying the info? Feb must have been the 4th month of the rental.pikov22 wrote:Claims from COPD Services (my DME):
Dec/Jan/Feb CPAP device rental
Supplier charged $119/119/119
Medicare approved $93/93/70
Medicare paid $74/75/56
You may be billed $19/19/14
Is it weird that they approved a different amount for Feb, and different pay-backs each month???
Oh -- note D: "Payment is reduced by 25% beginning the 4th month of rental." Really???
Is this from a Medicare Summary Notice, or something else? The Summary Notices I receive show all payments to the penny.
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