Digestive Health Center

Mr [redacted] phoned our office on June 3, and scheduled an EGD for July 10, During the scheduling phone call, he indicated that Medicare was his primary and only insuranceDr [redacted] and Digestive Health Center do not participate with Medicaid, and we would not have seen Mr [redacted] if he had been on MedicaidUpon Mr [redacted] 's arrival on July 10, 2013, he presented his Medicare card and signed a registration form acknowledging that he was "responsible for [his] billing including any amount not covered by [his] insurance." Mr [redacted] was subsequently seen for a colonoscopy on July 12, Dr [redacted] had a phone conversation with Mr [redacted] regarding a prescription several weeks after his procedures on July 26, Dr [redacted] documented the call in Mr [redacted] 's file, stating that that the patient was "trying to get Medicaid" at the time of the call, thus indicating that the patient was not active with Medicaid at the time of his services in our facilityAfter submitting the EGD and Colonoscopy claims to Medicare, Medicare specified that Mr [redacted] was responsible for a portion of the encounters totaling $It is common for Medicare patients to owe a small balance for their proceduresTherefore, when the $bill was not paid by the patient in a timely manner, our office authorized his account to be turned over to a collections agencyIt was reported to the credit bureaus in March Our office received a phone call from Mr [redacted] on April 17, regarding the bill in collectionsThe patient was advised to call the collection agency about the matter as we no longer handled the billBefore hanging up, the patient stated that he was "going to make files against us" over this situationThe next correspondence our office received from Mr [redacted] was another phone call on September 30, 2014, during which he threatened to sue Dr [redacted] for malpractice over this billing issueSince a dispute over $is not worth starting a law suit, our office had the $pulled from collections and written off on October 3, to avoid any further confrontation with Mr [redacted] The collection company indicated that they notified the credit bureaus on October 19, 2014, and that the complete removal process can take up to days to be reflected on the patient's credit reportMr [redacted] faxed our office a 2-page letter dated December 18, accusing our office of billing his procedures inappropriately and demanding nearly $11,for the time and expenses he incurred while dealing with this collection issueHis account was reviewed, and it was determined that Mr [redacted] 's encounters were billed correctlyWe responded to the patient's letter in a correspondence dated December 23, The letter stated that the patient's procedures were billed correctly and that he neither held a balance with our office nor had any collection matterAfter receipt of the patient's December 18, letter, our third party billing company informed us that Medicare customarily forwards claims to Medicaid if/when Medicaid is a patient's secondary insuranceHowever, these claims were not forwarded to Medicaid per Medicare's practice, which is further evidence that the patient was not active with Medicaid at the time of serviceIt was noted by our billing service, though, that an eligibility check on Medicaid's website showed that the patient was active during the month of July 2013, and that it is possible that Mr [redacted] 's Medicaid policy was retroactively instatedThis does not change the fact that our office and facility do not participate with MedicaidOur office has already done everything we could in this matterWe do not see any further action to be taken on our part since the patient never made any payments toward his initial balance and no longer owes us any moneyPlease contact me should you require additional supporting documentation to resolve this matterSincerely, [redacted] Administrator

Mr. [redacted] phoned our office on June 3, 2013 and scheduled an EGD for July 10, 2013. During the scheduling phone call, he indicated that Medicare was his primary and only insurance. Dr. [redacted] and Digestive Health Center do not participate with Medicaid, and we would not have seen...

Mr. [redacted] if he had been on Medicaid. Upon Mr. [redacted]'s arrival on July 10, 2013, he presented his Medicare card and signed a registration form acknowledging that he was "responsible for [his] billing including any amount not covered by [his] insurance." Mr. [redacted] was subsequently seen for a colonoscopy on July 12, 2013.
Dr. [redacted] had a phone conversation with Mr. [redacted] regarding a prescription several weeks after his procedures on July 26, 2014. Dr. [redacted] documented the call in Mr. [redacted]'s file, stating that that the patient was "trying to get Medicaid" at the time of the call, thus indicating that the patient was not active with Medicaid at the time of his services in our facility.
After submitting the EGD and Colonoscopy claims to Medicare, Medicare specified that Mr. [redacted] was responsible for a portion of the encounters totaling $231.03. It is common for Medicare patients to owe a small balance for their procedures. Therefore, when the $231.03 bill was not paid by the patient in a timely manner, our office authorized his account to be turned over to a collections agency. It was reported to the credit bureaus in March 2014.
Our office received a phone call from Mr. [redacted] on April 17, 2014 regarding the bill in collections. The patient was advised to call the collection agency about the matter as we no longer handled the bill. Before hanging up, the patient stated that he was "going to make files against us" over this situation.
The next correspondence our office received from Mr. [redacted] was another phone call on September 30, 2014, during which he threatened to sue Dr. [redacted] for malpractice over this billing issue. Since a dispute over $231.03 is not worth starting a law suit, our office had the $231.03 pulled from collections and written off on October 3, 2014 to avoid any further confrontation with Mr. [redacted]. The collection company indicated that they notified the credit bureaus on October 19, 2014, and that the complete removal process can take up to 90 days to be reflected on the patient's credit report.
Mr. [redacted] faxed our office a 2-page letter dated December 18, 2014 accusing our office of billing his procedures inappropriately and demanding nearly $11,000 for the time and expenses he incurred while dealing with this collection issue. His account was reviewed, and it was determined that Mr. [redacted]'s encounters were billed correctly. We responded to the patient's letter in a correspondence dated December 23, 2014. The letter stated that the patient's procedures were billed correctly and that he neither held a balance with our office nor had any collection matter.
After receipt of the patient's December 18, 2014 letter, our third party billing company informed us that Medicare customarily forwards claims to Medicaid if/when Medicaid is a patient's secondary insurance. However, these claims were not forwarded to Medicaid per Medicare's practice, which is further evidence that the patient was not active with Medicaid at the time of service. It was noted by our billing service, though, that an eligibility check on Medicaid's website showed that the patient was active during the month of July 2013, and that it is possible that Mr. [redacted]'s Medicaid policy was retroactively instated. This does not change the fact that our office and facility do not participate with Medicaid.
Our office has already done everything we could in this matter. We do not see any further action to be taken on our part since the patient never made any payments toward his initial balance and no longer owes us any money. Please contact me should you require additional supporting documentation to resolve this matter.
Sincerely,
[redacted]
Administrator