Medicare Progress

No, this isn’t a post about Medicare for All (which is a great goal, but a problematic 2020 campaign platform, in my humble opinion). But this post is about you, if you have Medicare and are seeking psychotherapy, and me, in my quest to be able to provide you with services.

I signed up to be a Medicare provider four years ago, and got my “PTAN” (provider transaction access number). I tried submitting paper claims to National Government Services, the Medicare contractor for Illinois, but they were rejected. I signed up for online claim submission through NGS Connex, but couldn’t figure out why there was no way to submit claims. So recently, I decided to grit my teeth and get this done. I spent at least an hour on the phone and it took three weeks, but I think it’s finally working. I found I hadn’t signed up as a provider with my own organization (even though I was already good as a user, and as my own “LSO” or Local Security Officer). I also hadn’t yet enrolled in EDI (Electronic Data Interchange) with NGS. so I did that.

I think there are more acronyms with Medicare billing than there are in the military!

Anyway, that should leave me ready to go. So if you have Medicare Part B, I can work with you. If you have a Medicare supplement plan or a secondary plan from a retirement fund or previous employer, that should be OK too.

Regarding Medicare Advantage plans, check your provider list and benefit book. If it’s a PPO and I’m on the network, I should be OK without Medicare Part B billing. If it’s a Medicare Advantage HMO, I may not be covered, since you probably need a referral from your primary physician and need to stay within their group.

So I feel like I met a real challenge here. Medicare billing seems to be geared toward people who have a billing service, and I’m doing it all on my own. But I got some great suggestions and support from other members of the Chicago Therapists listserv.

CC BY-ND 4.0 Medicare Progress by Fitzgerald Counseling is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.