CMS 1500

I am entering a new realm of medical billing.

I should have seen this coming. Last month, I had a very nice older gentleman who called me and requested my services. I should have realized that since he was older than 65, his insurance through my panel was his secondary insurance, and his primary insurance was managed through MediCare. And I should have avoided taking him on. That's right. There are times when the hassle of getting paid will make me simply say no. Usually, when people with MediCare call me, they are upfront about it and I never actually think twice about saying, "I am sorry, I am not currently accepting MediCare patients." And that would be that. However, like I said, I was not paying attention and even though I knew he was born long, long, long time ago, it didn't occur to me. So anyway, we established a therapeutic relationship and he had been quite a hard working patient and therapy itself had gone very well.

I billed the insurance panel, and they rejected my claim. I called customer service and had the following exchange:

(A very long, lengthy discussion about which patient, who I am, dates of service, blah, blah, blah, blah, blah...)
Me: "So, Mr. MediCare's claim was denied, and what does that mean, exactly? I thought he had received authorization?"

Rep: "It shows that you need to bill MediCare then send in the paperwork from them, and then we will send you the difference."

Me: "I am new to this, so please help me. How do I do this?"

Rep: "You use the form."

Me: "What form? Do you have it? Can you fax it to me?"

Rep: "We don't have the form here. You need to call Federal Form Agency and request the claim form. Their number is 202-xxx-xxxx."

Me, thinking, "Ok. What claim form is this? Does it have a number? I bet the Federal Form Agency has lots of different claim forms, you know, for tax rebates, legal services, whatever."

Me: "Is there a number attached to this form? How do I ask for this?"

Rep: "This is the form used by all doctors to bill all the time."

Me, thinking, "Ok. Not all doctors, since I don't have one. And if it is used by ALL doctors for ALL billing, how come, YOU, a BILLING CALLING CENTER, do not have this form?!"

Me: "Hmm. I guess just not this doctor. So how do I get this form?"

Rep: "It is form CMS 1500."

Me: "Ok, thanks. Bye."

I hung up. Then I decided to call a patient. I picked up the phone, got ready to dial, but then, I realized that SHE WAS STILL ON THE PHONE! And, SHE WAS MAKING FUN OF ME to her colleague about the fact that I didn't know the existence of a form that was so universal that even they didn't have it!

I waited patiently for her to finish. Then I said, "And that doctor is STILL ON THE PHONE with you. I would like to speak to your supervisor." She hung up on me immediately, but the system automatically forwarded me to a survey to evaluate my satisfaction with the rep. I gave them a piece of my mind. And I should have demanded to know what CMS stood for while she was being all condescending. (FYI, CMS is for Center of MediCare/MediCaid Services. And so, it is NOT a claim form used by ALL doctors for ALL billing.)

Anyway, billing sucks.

By the way, having a nationalized health care insurance system like MediCare for everyone, does NOT mean health care for everyone. People like me, when able to pay attention, opt out of taking care of people with MediCare and MediCaid, because well, billing for that just SUCKS. SUCKS. Did I mention that it just SUCKS? Also, the reimbursement SUCKS even more.

Ok, I need to go think about something more pleasant before bedtime, like the Mothers' Day Breakfast with Aidan and Zoe at school tomorrow AM!