Thomas Nicolla Consulting Services

In response to your letter dated 1-4-for the above patient.On 4-22-this is what we found out from Medicare for a date of service of 10-10-Medicare denied on 10-20-as the patient could not be identified as their insuredI called the Medicare IVR line that same day, eligibility,
the beneficiary’s coverage is not effectivePer the patient’s intake form dated 10-10-2014, she listed her Medicare ID# as primary, but the only copy we had of an insurance card was a *** *** cardI went into the *** *** website on 4-22-and it states *** *** is primary.Date of service 10-17-2014, per *** ***, Medicare pays benefits before your group health planSince the patient did not enroll with Medicare Parts A and/or B or used a facility of the federal government, we processed this claim after estimating how much Medicare Parts A and/or B would have coveredIf the member is not enrolled in Medicare, the patient is responsible for the difference between the billed charge and the amount paid by this planOn 10-28-2015, I called *** ***, because the patient was eligible for Medicare Parts A and B, but did not enroll with Medicare Part B, *** *** is estimating how much Medicare Part B would have paid, we can bill the patient, we would be willing to adjust down to our private pay fee of $for each date of service.The total patient responsibility is a total of $250.00, physical therapy sessions @ $50.00(private pay) =$250.00.A statement went out to the patient dated 11-30-for a balance due of $I received a call from the patient on 12-7-wanting to know why she received a bill?I called the patient back I did mention to her that it is the patient’s responsibility to know their benefits and whether or not they are coveredShe asked me if there was anything we could do in regards to the balance on her account, I said no, we are billing private pay rates at $each, and we won’t adjust any lowerPrior to 12-7-there were no complaints from the patient about patient care. Then I went over our payment plan with her, we generally like to have the balance paid in months, if she cannot afford then we would be willing to go monthsWe went over what her payments would be for months, 1st payment and 2nd payment would be $each and the 3rd payment would be $She is not sure what she is going to do, if she is going to pay all at once or the monthly paymentsI asked her to let me knowShe thanked me for all of my help and we have not heard from the patient since our last discussion on 12-7- If you have any questions, please feel free to call us at *** *** between the hours of 8:AM to 4:PM, Monday thru Friday.Thank You,Thomas *** PT Associates