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    Correcting an address with Medicare

    Q: I am a solo practitioner dealing with a huge Medicare problem. Earlier this year, my electronic billing company accidentally omitted a digit from my billing address. That error caused Medicare to question whether my practice actually exists and required me to fill out a 20-page application. Then I made an error in formatting the application's date, causing Medicare to say it never received my paperwork. When I finally got the application correct, Medicare told me approval can take up to 150 days. Meanwhile, Medicare has disowned me and sent letters to my patients, saying their bills will not get paid. What should I do? Do I stop taking Medicare patients because I am not getting paid? What should I tell my patients to do? Every time I call Medicare, I'm on the phone for an hour without resoluion.


    Thomas J. Ferkovic, RPh
    A: Unfortunately, the Centers for Medicare and Medicaid Services has uncovered fraudulent billing by providers with store-front offices and has targeted this segment in a crackdown.

    First, your clearing-house should assist you in correcting its error. Regardless, call Medicare again and speak with a supervisor in provider enrollment to get your address corrected in its records. When the billing company sent documentation with the incorrect address, they should have just been able to file an application (whichever 855 application that applies to your practice) to get that error corrected.

    Second, when you say "disowned," do you mean that Medicare has de-activated your Provider Transaction Access Number/billing privileges? If so, send in a new, fully completed 855 application requesting that the practice be reactivated. You need to do this as soon as possible, because Medicare only backdates 30 days from when it receives a correct application.

    If by "disowned" you mean that Medicare revoked your practice's billing privileges, you can appeal by filing a rebuttal and demonstrating that your practice meets the enrollment requirements. This appeal must be supported by any related documentation and records that Medicare requests. A provider enrollment supervisor can explain what your current inactive status is and how to rectify the situation. In the meantime, draft a letter to your Medicare patients, with a copy to the clearinghouse and Medicare, explaining the issue.








    Answers to readers' questions were provided by Thomas J. Ferkovic, RPh, MS, managing director, SS&G Healthcare Services LLC, Akron, Ohio. Send your practice management questions to

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