Jump to content

Sign in to follow this  
SptsMed

Question about CMS DRG

Recommended Posts

My younger brother went through a period of time in which he was uninsured due to job situation. Anyway during that time he had an ER visit for a fracture and the bill was sent to collections. I am trying to help him clean up his report and he is willing to pay the OC via the Hippa letter course, but was trying to figure out how to find the reimbursement for ER visit and CT scan to pay the allowable. He also had surgery with an outstanding anesthesia bill that is in collections as well. Any help on trying to locate that information as far as the discounted or Medicare amount to pay would be greatly appreciated.

Share this post


Link to post
Share on other sites

My younger brother went through a period of time in which he was uninsured due to job situation. Anyway during that time he had an ER visit for a fracture and the bill was sent to collections. I am trying to help him clean up his report and he is willing to pay the OC via the Hippa letter course, but was trying to figure out how to find the reimbursement for ER visit and CT scan to pay the allowable. He also had surgery with an outstanding anesthesia bill that is in collections as well. Any help on trying to locate that information as far as the discounted or Medicare amount to pay would be greatly appreciated.

The HIPAA letter program has a link within insert "a" to the normal and usual charges.

http://www.cms.hhs.gov/HealthCareConInit/

 

Make sure he follows ALL the steps before paying anyone anything, especially if the dates of service are over 2 years old.

 

Opt out

http://whychat.5u.com/OPTOUTINST.HTML

Delete old addresses, if possible

 

Send the initial dispute letter to each CRA for any and all medical accounts reporting.

http://whychat.5u.com/hipaadisp.html

IF he gets a response from the reporting CA's that provides him with accurate account information AND the CRA's state that the account is verified, he can THEN pay the OC using the language in insert "a" referring to the normal and usual charges.

http://whychat.5u.com/hipltr.html

OTHERWISE, he should NOT pay anything as it would mean that the account was written off and paying would NOT result in any deletion.

 

If the accounts are verified by the CRA's WITHOUT a valid response from the CA, then he needs to send the reporting CA(s) this;

http://whychat.5u.com/ltrcavalhipaa.html

And follow up with this;

http://whychat.5u.com/ltrcavalhipaa.html#DISPUTE

Share this post


Link to post
Share on other sites

He has received nothing as of yet, outside of the computer generated letters from TU and EQ. He did pull his EQ report last week and it was showing as disputed reinvestigation. This week that is gone from the report but nothing has come via mail as of yet. The date of service was back in December of 2006, although he can not find any of his original documentation. Since this has gone past two years are you suggesting that he not pay if it comes back as verified due to time lapse and potential write offs already having been taken by the hospital ?

Share this post


Link to post
Share on other sites
He has received nothing as of yet, outside of the computer generated letters from TU and EQ. He did pull his EQ report last week and it was showing as disputed reinvestigation. This week that is gone from the report but nothing has come via mail as of yet. The date of service was back in December of 2006, although he can not find any of his original documentation. Since this has gone past two years are you suggesting that he not pay if it comes back as verified due to time lapse and potential write offs already having been taken by the hospital ? Without proper and complete validation from the reporting CA there is NO point in paying the hospital anything, as he would not get a deletion

Since it has already been deleted from his Eq report, I suggest you wait until you get the letter of deletion from Eq and a response from TU. Was this on his Experian report also??

 

A "verification" from a CRA is not sufficient to validate the account.

 

If you ever get a response directly from the reporting CA that provides a FULL account statement that matches your records, you can THEN pay the OC directly with the HIPAA letter insert "a".

 

I doubt very much that you will need to do that as it apparently has already been deleted from Eq and will most likely be deleted from TU.

Share this post


Link to post
Share on other sites

I have often wondered with bills from hospitals in general that are beyond two years what the ramifications were since most of the time they have been written off as bad debt and have been partially recaptured when they file their medicare cost reports at years end. The situation I had several years back with my sons surgery and getting denied by insurance on a claim of pre-existing left me with several non paid balances. I ended up paying the two main ones almost three years after the fact due to the fact that I do have some business relations with them, but I am sure the debt had probably already been written off and claimed on their yearly cost report.

Share this post


Link to post
Share on other sites
I have often wondered with bills from hospitals in general that are beyond two years what the ramifications were since most of the time they have been written off as bad debt and have been partially recaptured when they file their medicare cost reports at years end. The situation I had several years back with my sons surgery and getting denied by insurance on a claim of pre-existing left me with several non paid balances. I ended up paying the two main ones almost three years after the fact due to the fact that I do have some business relations with them, but I am sure the debt had probably already been written off and claimed on their yearly cost report.

You raise a very important issue.

 

There are several types of hospital bills that are reported as collections on folk's credit reports.

 

1- A legitimate balance that is actually owed to the hospital and SHOULD BE PAID TO THE HOSPITAL, ( insert "a")no matter HOW long ago the date of service was. This STILL requires going through the initial HIPAA dispute process in order to document the CURRENT relationship between the hospital and the reporting CA. There is no effective "legal" SOL for legitimate bills, because IF the hospital was reimbursed by tax$$ for "no-pays" they are OBLIGED by law to make every effort to collect on these accounts. If someone is sued on such an account, a "SOL" defense will NOT work as the Courts have held that such an account is exempt from the "SOL" statutes because of the tax payer funding that is being recovered.

 

2- A balance that is NOT correct due to a billing error or late insurance payment that is reported by a CA with a current relationship with the OC, again this MUST be established and documented by the HIPAA initial dispute and followed up with the HIPAA letter to the OC insert "b".

 

3- An account that is NOT YOURS, either a billing error that billed you for someone else, ( insert"c") or ID theft/fraud which requires a lot of work and filed ID theft reports to get removed.

 

4- The most common medical collections on reports are those placed there by CA's who have NO relationship whatsoever to the OC. They obtain their information from a variety of sources, mostly data miners who sell the information to them. There is NO POINT in contacting the OC on these "garbage" accounts as the OC has not provided the data to them and can have no influence on their deletion.

Share this post


Link to post
Share on other sites

Whychat,

 

He just received his notification from EQ and it states that they verified the account to be his. All disputes were sent CMRR on the same day and he has received all the green cards with April 20th being 30 days on all disputes. EQ had listed the account as disputed by consumer, then removed that statement and now he has received notification that they state it to be verified. He has not recieved anything from EX at all, and has just recently received the computer generated letter from TU that always comes prior to the official notification either way. The DOFD is different on each CRA report as well, and as of this time he has not received anything directly from the CA.

 

I advised my brother to opt out about a year ago, but obviously he did not do that as since he applied for the re-fi all kind of creatures are coming out of the woodwork.

Share this post


Link to post
Share on other sites
Whychat,

 

He just received his notification from EQ and it states that they verified the account to be his. All disputes were sent CMRR on the same day and he has received all the green cards with April 20th being 30 days on all disputes. EQ had listed the account as disputed by consumer, then removed that statement and now he has received notification that they state it to be verified. He has not recieved anything from EX at all, and has just recently received the computer generated letter from TU that always comes prior to the official notification either way. The DOFD is different on each CRA report as well, and as of this time he has not received anything directly from the CA.

 

I advised my brother to opt out about a year ago, but obviously he did not do that as since he applied for the re-fi all kind of creatures are coming out of the woodwork.

Are you saying he started the dispute process without opting out??

 

He will need to send the medical DV to the reporting CA

http://whychat.5u.com/ltrcavalhipaa.html

Share this post


Link to post
Share on other sites

He swears that he went online and opted out, although he is getting creatures out of the wood work now. He has lived in the same house for going on ten years though, anything that is truly his would be from that address.

 

So send the DV to the reporting CA even though he has not heard from them since disputing with the CRA's ? And then once he receives the green card back, wait five days and then send the second dispute to the CRA with a copy of the DV included ?

Share this post


Link to post
Share on other sites
He swears that he went online and opted out, although he is getting creatures out of the wood work now. He has lived in the same house for going on ten years though, anything that is truly his would be from that address.

 

So send the DV to the reporting CA even though he has not heard from them since disputing with the CRA's ? And then once he receives the green card back, wait five days and then send the second dispute to the CRA with a copy of the DV included ?

If he is opted out his reports would show that. Yes, you are correct on the follow up dispute.

Share this post


Link to post
Share on other sites

Updating the situation from my original post. Not long after sending the first round of disputes out my brother got hit with two other CA placements on all 3 CRAs. He followed the same process with medical dispute first.

 

Results so far, all 3 CRAs verified the first dispute, no communication of any type from the CA on that dispute. The second round of disputes very soon after that one for the new accounts were verified as well. One of them he received a call from the OC validating in which he sent the HIPPA letter with the insert to pay it to the OC. Sent money order, endorsed to the OC with all prevelent documentation. The other one he has not heard anything from as of this date.

 

He sent the DV to all CA and as soon as he received the green card back in the mail, he attached a copy of the DV, a copy of the CMRR card and sent the follow up dispute to the CRAs. Yesterday he received two form letters, one from EQ and one for TU in reference to a fraud alert that had been placed on his credit reports for 90 days.

 

Is this a new tactic by the CRAs to avoid actually investigating a dispute on medical collections ? It has only been about a week and a half since they received the second dispute. I told him it was probably a new form letter they are sending out, but I have not seen anyone else respond about getting on on here and I never did when I used this approach on my report 4 years ago.

 

Thanks once again for the input and help

Share this post


Link to post
Share on other sites
Updating the situation from my original post. Not long after sending the first round of disputes out my brother got hit with two other CA placements on all 3 CRAs. He followed the same process with medical dispute first.

 

Results so far, all 3 CRAs verified the first dispute, no communication of any type from the CA on that dispute. The second round of disputes very soon after that one for the new accounts were verified as well. One of them he received a call from the OC validating in which he sent the HIPPA letter with the insert to pay it to the OC. Sent money order, endorsed to the OC with all prevelent documentation. The other one he has not heard anything from as of this date.

 

He sent the DV to all CA and as soon as he received the green card back in the mail, he attached a copy of the DV, a copy of the CMRR card and sent the follow up dispute to the CRAs. Yesterday he received two form letters, one from EQ and one for TU in reference to a fraud alert that had been placed on his credit reports for 90 days.

 

Is this a new tactic by the CRAs to avoid actually investigating a dispute on medical collections ? It has only been about a week and a half since they received the second dispute. I told him it was probably a new form letter they are sending out, but I have not seen anyone else respond about getting on on here and I never did when I used this approach on my report 4 years ago.

 

Thanks once again for the input and help

The fraud alert is standard, and is actually a beneficial thing as it will help get deletions.

Share this post


Link to post
Share on other sites

Thanks once again, I do not think I will ever have read these forums enough to ever feel like I completely understand it all LOL. I will post once he gets back the full results.

Share this post


Link to post
Share on other sites

Updating the situation. Sent CRA initial disputes, all three verified with no communication from CA. Sent special medical DV with copies for each CRA enclosed, once green card was received sent the second dispute to all CRAs via CMRR. TU deleted, EQ and EX verified once again with no information still from CA. Fraud alerts placed on all three reports. Do I repeat the steps again at this point on EX and EQ or move to filing complaints and sending demand for deletion since they obviously did not follow the procedural request ?

Share this post


Link to post
Share on other sites
Updating the situation. Sent CRA initial disputes, all three verified with no communication from CA. Sent special medical DV with copies for each CRA enclosed, once green card was received sent the second dispute to all CRAs via CMRR. TU deleted, EQ and EX verified once again with no information still from CA. Fraud alerts placed on all three reports. Do I repeat the steps again at this point on EX and EQ or move to filing complaints and sending demand for deletion since they obviously did not follow the procedural request ?

Yes, time to file an FTC complaint against Eq and Ex

 

http://whychat.5u.com/hipaaftccomp.html

Share this post


Link to post
Share on other sites

Thanks as always for the advice and help, I will go online and file the complaint and send it with a demand for deletion for not properly investigating and post when I hear anything back again.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

  • Today's Birthdays

  • Member Statistics

    • Total Members
      175,570
    • Most Online
      1,528

    Newest Member
    HelpMeRhonda221
    Joined

About Us

Since 2003, creditboards.com has helped thousands of people repair their credit, force abusive collection agents to follow the law, ensure proper reporting by credit reporting agencies, and provided financial education to help avoid the pitfalls that can lead to negative tradelines.
×

Important Information

Guidelines