Slovin Family Chiropractic Center, P.C.

Complaint: [redacted]
I am rejecting this response because:
class="MsoNormal">Response to Dr. Erik S[redacted]’s Rebuttal
Dr. S[redacted]’s rebuttal is not responsive to the essential
elements of my claim.
He failed to address the issue that Medicare Guidelines state
that a provider must have a Medicare Provide Number and a National Provider
Identifier, at the time of service, to file claims for service. Dr. Eric S[redacted]
had neither.
In addition, he has not provided documentation that his
treatments were medically necessary as required for reimbursement from Medicare
and secondary insurance.
The citing of a signed ABN is invalid since my signing was
predicated on my belief and assurance that Dr. S[redacted] would submit a valid
claim to Medicare. Medicare has determined he could not submit a valid claim
due to his lack of proper documentation. In addition Medicare has determined
that Slovin Family Chiropractic is responsible for the cost of the service. Please
see Medicare’s decision attached.
Regarding the unnamed National Government Service
Specialist, I question if they were given all the information regarding Dr.
S[redacted]’s lack of proper documentation. Why would one reference the Medicare
Processing Manual as a defense when Dr. S[redacted] is probably in violation of the
Mandatory Claim Submission Rule for failing to have the required Medicare
Identification numbers.
Therefore, I renew my claim for reimbursement.
Thank you,
[redacted]

Review: I went to Dr. Eric S[redacted] (Chiropractor) for a back issue. He treated me from 12/29/14 to 1/21/15. Prior to any treatment, I informed Dr S[redacted] that I was covered under Medicare and had supplemental coverage. I asked if he was a Medicare provider and if he could submit the claims to Medicare. He said he was but he informed me that Medicare may not reimburse me but he would submit the claims. I told him that Medicare was the first step and I would pursue the reimbursement issues with Medicare and my insurance company.

After repeated attempts to have him submit the claims, they were submitted and rejected.

I appealed the decisions.

Medicare's final determination was that the Slovin Family Chiropractic Center did not have a Medicare provider number and a National Provider Identifier Number that was valid on the dates of service. Medicare stated that a their guidelines require a provider to have a Medicare Provider number and National Provider Identifier number to file claims for payment. There decision was that "Slovin Family Chiropractic Center was responsible for the cost of the service:.

After repeated requests for information regarding the Medicare/ National Provider numbers and a Letter of Medical Necessity (required for reimbursement) Slovin Chiropractic y finally admitted that during the time of my treatments they were having problems with with their documentation. They finally acknowledged that they did not have the necessary numbers at the time of treatment. They never sent a Letter of Medical Necessity that was a required submission with all claims.Desired Settlement: Reimbursement of all charges due to Medicare's determination the Slovin Family Chiropractic is responsible for the cost of the service.

Business

Response:

Our office has received your complaint from the Revdex.com. Our insurance biller is reviewing the case. Thank you for your patience as we work to resolve this issue.