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Problems keep surfacing with Medicare claims By
JOHN HULTGREN LOUISVILLE — Hardin County EMS has had all of their recent Medicare claims denied for lack of a current license -- despite the fact that they hold a certified mail receipt signed by AdminaStar-Federal showing the license was received. [See related article.] AdminaStar recently promised that updated provider license information would not be a problem during the transition between the Kentucky EMS Branch and the new Kentucky Board of Emergency Medical Services. "Now Hardin County is going to have to go back and refile all of the claims that were denied due to AdminaStar's error," said Mike Swift, president-elect of the Kentucky Ambulance Providers Association. Swift recommended that all provider's whose ambulance licenses are nearing expiration send the information to AdminaStar by certified mail, return receipt requested, and document calls to AdminaStar requesting receipt of license status. But that's not the only problem. AdminaStar recently paid a batch of Medicare claims submitted by Barren-Metcalfe County EMS to the beneficiary. "When AdminaStar's telephone rep was questioned, we were advised that the electronic submission had indicated that we had received a partial payment from the beneficiary despite the fact that nothing in the claims that we printed indicated any such payment," said Swift today. Swift is also the director for Barren-Metcalfe County EMS. "When the telephone rep was advised of our researched findings, we were advised to 'bill the beneficary' to obtain the balance of our payment," Swift added. And here's another problem. "Several providers who submit paper claims, or who have requested reviews with additional documentation, have indicated that they have experienced denials due to not having the actual beneficiaries' signature," Swift said. Under certain conditions, the Health Care Financing Administration allows signatures by parties other than the beneficiary. "I know that you must be getting tired of my pleas, but we need all of your continued efforts and support. I think that we finally have HCFA's attention and we have much to get done while they are listening," Swift said.
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