One of the more irksome parts of my job is dealing with difficult insurance companies, as I do the billing for things that aren't automatic through our prescription software. The two that are most difficult to interact with and are the most frustrating are Medicare and Medicaid. One of the biggest chunks of time I spend with that stuff is dealing with Medicare billing for things like test strips, lancets, catheters, etc. We had to go through a huge accreditation process to be able to bill for those things and since then, it seems like it's getting worse and worse. The worst part is the documentation they require, but I'll go into that later. My newest gripe with them is their process for reversing claims. With prescription drugs, you can simply reverse the billing through the computer and everything happens in a matter of seconds. Try that for Medicare, though, and you get a message that says "this claim cannot be reversed because it has already been captured by Medicare." Great… But, like every government organization, they have a form for every job.
One situation that would require this form is if we refill someone's test strips then they end up going to long-term care or decide they don't want them after all. Before anything can happen, the claim has to be processed and paid, which can take 2-3 weeks. Then, when the claim is paid, I have to fill out a full-page form documenting the payment. To do this, I basically copy information off the stuff that Medicare just sent me, so I can send it back to them. Good use of time, right? There is an option for "immediate offset" where you don't have to send a check, but they just subtract the reversal amount from a future payment. I select that, then fax the form back. Then, I wait about a month. Typical turn-around time for Medicare/Medicaid paperwork… I did this for the first time a few months ago, so I didn't know what to expect. When they finally responded, I got a letter saying something like this: Our information indicates that the patient did not receive this product/service. Therefore you have been overpaid and must remit this amount immediately to avoid incurring interest.
Duh! The information they speak of is the form that I sent THEM telling them that the patient didn't get their test strips for whatever reason. So basically, I filled out all this paperwork telling them to please take back their money and then got a letter insinuating that I knowingly billed for services not rendered and they somehow found out about it. It's kind of like situations I've heard of elsewhere where the boss asks for an overview of some procedure that an employee has come up with to complete a task then comes back saying "this is how you need to be doing things." Well of course it is! That's what has been going on all along and what the employee just passed on to the supervisor. I think it must just be a power issue.
It's very nice to be on a break from school. I am working almost every day, but no matter how my time is spent, I'm much more content when school is out of session. I've been able to spend time with some friends, catch up on a couple TV shows, and learn how to crochet. Plus I just watched A Christmas Carol for the first time. I'd seen some animated version a long time ago but had never seen the real movie version. I tried to go shopping today, but didn't end up finding any Christmas gifts (besides the new wallet and shirt I found for myself…) Maybe tomorrow…
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