Forum - Questions & Answers

Apr 17th, 2015 - Kare

Who is responsible for a bill

Good Afternoon,

I had a patient come into my office with Rx from her doctor ordering her a new leg brace. This was November 1, 2014. We advised her was not sure if Medicare would help her again with a new brace so had her sign ABN form due to Medicare states they will consider new brace every 3 to 5 years unless something about patients needs change or something happens to existing brace it could deny. We were in process of making brace was not informed that patient went into acute care on Nov 29,2014 .. then to skilled nursing on Dec 10 , 2014 .. Then was transferred back to acute care as of Jan 1, 2015. To my knowledge she is still there today. I called in and spoke to a Jeff at Medicare who gave me the NPI and the above info and stated that the facility patient was in is responsible. When I called I spoke to a Mrs. Shantley and she stated she did not feel like they were responsible due to the order was prior to the patient entering into their facility and that if the patient needed it she would have had their physical therapy department make on behalf of the patient. I explained brace and order was already in process and that it could not be unmade patient has seen us as well as the referring physician and it was patients choice. I called back to Medicare and spoke to two separate persons making sure I am doing all the legal processes. I spoke to Jeffrey and he confirmed the facility is responsible and advised me to print off chapter 6 article and send with bill. I will say Medicare paid the claim then recouped due to patient being in facility. I have returned monies to Medicare. I have not received not one response from the facility wanted to make sure was handling properly prior to going forward with collecting the money.

Thank you so much in advance for any input on the above

Karen Elmore



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