
06-19-2008, 07:00 PM
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Senior Member
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Join Date: Nov 2006
Posts: 1,433
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Quote:
Originally Posted by upagainstit
I am looking for help from ANYONE; I am desperate at this point, and will try to summarize the problem/issues/case here. We were a Medicare service provider, providing services to patients via our enrolled practitioner.
Issue 1: On 9/29/07, Medicare/First Coast deleted our practitioner, stating this was due to their not having received claims from us for a one-year period of time prior to that deletion date. We proved through their own documentation stamps that this was not true, and after months of back-and-forth, including intervention by Congressman Tim Mahoney (FL), they agreed that in fact, they'd received the claims within the required time frame, but that although they'd received them from us within the required timeframe, they themselves had not internally processed them (keyed them into the system) within that required one-year timeframe, and as a result, they are not required to pay us.
Issue 2: Medicare/First Coast own documentation states that on deletion of a practitioner, the provider shall not be paid for any services performed after the effective date of deletion. However, all the services for which we are requesting payment were performed PRIOR to the effective date of deletion. Medicare/First Coast refuses to address this issue.
This problem has gone past the point of collecting the monies due us on these claims. As a result of the length of time involved in this problem which Medicare/First Coast (which actually extends back to the fall of 2006), we were unable to retain a practitioner, were forced to discontinue accepting Medicare, and lost all our clients - ultimately destroying our business.
Can anyone offer any assistance/advice? PLEASE!! I am close to facing personal bankruptcy at this point.
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Let me preface my statements by saying my specialization is in criminal law--NOT civil law. That being said, my opinion is simply that with something of this magnitude, and with so much to lose, you really need to hire an attorney. The laws pertaining to this subject matter are a labyrinth of details---and you really need the best legal representation you can get, if you want to prevail.
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