i dealt with both Medicare and NY Medicaid within the course of about 90 minutes this morning.
I first dealt with NY Medicaid, as I had to submit a claim for a patient. Using NY Medicaid’s ePACES application, I was able to submit a claim for real-time adjudication! When I had a question about one of the boxes on the claim form, I called the eMedNY help desk [eMedNY basically is the people behind NY Medicaid]–instantly got a human CSR and was able to straigten things out. The CSR (whose name I can’t remember) was extremely polite, friendly and curtious–as have all of the eMedNY CSRs I’ve interacted with. With ePACES you can even check eligibility online and in real time! (You can’t do that with Medicare!)
Then I had to check on the status of a Medicare application for one of our physicians.
A bit of background, said physician is already par with Medicare (just at a different address), has been par with Medicare for years, and we’re just trying to finally update our mailing address. we’re on our second application go around, after the first time, the CSRs at Medicare told us to submit the wrong form/application type.
So I made my weekly call in today to check on the status of our doctor’s application. First, I was on hold for 10+ minutes–and there wasn’t even any muzak or anything of the sort. Just dead silence [with an occasional pre-recorded announcement plugging their website]. At long last, a female CSR picked up.
We started with the usual: “Name, phone number, doctors name, NPI…” (aka the usual). I gave the case number and all the CSR did was give me a note from back in August saying that Medicare wanted more info (which we provided within 24h of the request).
When I proceeded to ask what the status of the application was, the CSR got snippy. She said she couldn’t give a time frame. I calmly and politely pointed out that by CMS’ guidelines, the application must be fully processed within 60 days–and asked if the application would at least be processed by Mid-October…
I must have pressed a button with her–as she started getting nasty. She claimed that our application is in the “queue” with the person who reviews the application and that we would just have to “wait”. Despite my attempts to inquire further she just repeated this same thing. [Later when I told my supervisor this–she wondered if there’s only 1 person processing the applications?]
Then I proceeded to ask about the application for a second doctor (because he too changed his address–a whole new application had to be completed–go figure]. I’d prepared his application using the online PECOS portal. The first application was denied because the people at Medicare scanned the supplementary paperwork wrong. This was the second app. It was sent back because the provider had to change his specialty listing. When I called PECOS’ help desk to ask how I could change the one field in the application, they told me that I unfortunately had to delete the whole application and start anew–but that it would sufficient.
Came to find out today, that because I followed the PECOS people’s advice–the providers application was rejected–and I have to send everything back in again! Ugh! [And again the CSR was horribly rude].
It was night and day between Medicaid and Medicare.
As my supervisor put it: “Imagine if these people (Medicare) are running the whole health system!”