SharonCollachi
Guest
Background: For the past 5 or 6 years, we have not seen patients with any of these plans (in the title), except for patients with Medicare primary and Tricare secondary. Before we stopped seeing them (Doc got mad at Tricare, long story), we had no problems with the Medicare/Tricare combo. Medicare forwarded to Tricare, Tricare processed and paid.
We had some patients that the local VA hospital would call and ask us to see, because they didn't have the proper specialists available. When that happened, they would send us an authorization, we would bill the VA, and we would get paid, no problem. Nearing the end of that timeframe, the VA hospital changed their billing/payment procedures and had us bill Wisconsin Physician Services (WPS). Due to the issues with payment, we stopped seeing those patients and stopped taking new ones from the VA.
Now the problem. Doc works at a rehab hospital (and has his outpatient practice). From the rehab hospital, we only get the information they give us, which they get from the acute care hospital. We never get copies of cards, only a facesheet. I'm a pretty good detective and can figure out most insurance issues (AND I can log into the acute care hospital's portal and get info that way as well).
I am confused as to who to bill and in what circumstances for these insurances, and how to determine that. I have a patient that went to the closest acute care hospital by ambulance, unconscious. Everything I got for our services in the rehab hospital said he had Medicare B. Running his eligibility showed the same thing. Medicare processed and paid and did not forward the claims anywhere. I sent the patient a statement for his portion, and made a note to call us if he had other insurance. He called and told me I needed to bill the VA. Great. Super. Yippee. <--sarcasm.
I billed "Triwest VA PC3" (after some online research to find out where to send the claim; mailing address is Madison, Wisconsin). I got an eob today that said the services were not payable without an authorization from the VA. I called and spoke to their claims department and told them that Medicare was primary, and they were secondary, therefore, the hospital did not seek authorization. The rep told me they only pay as primary. I asked her about that as I had not heard of any other governmental program (Tricare, GEHA, etc.) being primary to Medicare, particularly for someone who is retired and in their 70s. She said she has seen where both Medicare and the VA paid, and the provider had to refund Medicare. Are you all as confused as I am??
Does the VA program run parallel to, and independent of, any other programs? That's what it is looking like to me. I did log in to the Tricare4u portal and checked his eligibility (just in case he had Tricare as well), it says he is not eligible for Tricare, and then had a note of "documents only".
If he had gone to the VA hospital, they would have discharged him from there to the rehab hospital, and generated an authorization in the process. Because he was unconscious, they took him to the nearest hospital. I'm not exactly sure what to do now. I'm thinking send the patient another bill and a note that the VA didn't authorize his services, and to make an appointment to see his primary care doctor at the VA for assistance (when we had payment issues related to auth in the past, that I mentioned above, that's what the patient would do).
Help!
We had some patients that the local VA hospital would call and ask us to see, because they didn't have the proper specialists available. When that happened, they would send us an authorization, we would bill the VA, and we would get paid, no problem. Nearing the end of that timeframe, the VA hospital changed their billing/payment procedures and had us bill Wisconsin Physician Services (WPS). Due to the issues with payment, we stopped seeing those patients and stopped taking new ones from the VA.
Now the problem. Doc works at a rehab hospital (and has his outpatient practice). From the rehab hospital, we only get the information they give us, which they get from the acute care hospital. We never get copies of cards, only a facesheet. I'm a pretty good detective and can figure out most insurance issues (AND I can log into the acute care hospital's portal and get info that way as well).
I am confused as to who to bill and in what circumstances for these insurances, and how to determine that. I have a patient that went to the closest acute care hospital by ambulance, unconscious. Everything I got for our services in the rehab hospital said he had Medicare B. Running his eligibility showed the same thing. Medicare processed and paid and did not forward the claims anywhere. I sent the patient a statement for his portion, and made a note to call us if he had other insurance. He called and told me I needed to bill the VA. Great. Super. Yippee. <--sarcasm.
I billed "Triwest VA PC3" (after some online research to find out where to send the claim; mailing address is Madison, Wisconsin). I got an eob today that said the services were not payable without an authorization from the VA. I called and spoke to their claims department and told them that Medicare was primary, and they were secondary, therefore, the hospital did not seek authorization. The rep told me they only pay as primary. I asked her about that as I had not heard of any other governmental program (Tricare, GEHA, etc.) being primary to Medicare, particularly for someone who is retired and in their 70s. She said she has seen where both Medicare and the VA paid, and the provider had to refund Medicare. Are you all as confused as I am??
Does the VA program run parallel to, and independent of, any other programs? That's what it is looking like to me. I did log in to the Tricare4u portal and checked his eligibility (just in case he had Tricare as well), it says he is not eligible for Tricare, and then had a note of "documents only".
If he had gone to the VA hospital, they would have discharged him from there to the rehab hospital, and generated an authorization in the process. Because he was unconscious, they took him to the nearest hospital. I'm not exactly sure what to do now. I'm thinking send the patient another bill and a note that the VA didn't authorize his services, and to make an appointment to see his primary care doctor at the VA for assistance (when we had payment issues related to auth in the past, that I mentioned above, that's what the patient would do).
Help!