Appeals Reference Guide - Medicare Part B#! attached is what is occur but when one is a patient and the billing system which is a contract is illegally hacked into to alter the official info in defiance of the Medicare judges, than the chaos begins and loss of life and livelihood is put at risk as no one knows who to bill and medical sources have no idea what treatments will be paid for and to follow so the patient is not left with bills not paid for. And for us its been at times, best treatment covered not given as they limit us to what Medicare will pay for. etc. or even Medicaid for one on my policy who also has a Medicare card and it is the third payer and rarely would ever have Part B bill to be paid by them.
Plus under the current laws, only the patient and the medical provider are at legal risk and we bear the over payments to the government and fines and penalties can be assessed against the provider or supplier. for obeying the ACS et al sources and management teams and clearing houses who all get the hacked in misinformation . on those of us who have a primary employer group health plan. and the illegal software is run to delete it or in my case its sometime added back in as a medi gap policy ad its not.
Judge's ruling on M09 1406 is defied along with 37 other Judges my cases alone in multiple agencies by govt contractors which Congress in past years gave no budget for over sight and internal audit controls or have any money for criminal investigations as STEALING MEDICARE GOES ON DAILY and system 'coerces' all to engage in as they must use the CRIMINALLY ALTERED COMMON WORKING FILE. which is privately owned as has been all of our medical records since 1999 once they leave our doctor, etc. and not under the HIPPAA law as our doctor, etc is under. not even out insurer is not under it either since 2010..
So when things get mixed up in it an altered from what ones doctor sent in, them grave danger exists for even life to be sustained. and who gets sued? not he ones messing with all, but the medical source who was ordered to follow it. many are now getting wise to the unreliability of it. And medical research is skewed if used and ALL OF US SUFFER WHEN MEDICAL RESEARCH DOES NOT END UP WITH BEST OUTCOMES FOR NEW TREATMENTS AND CURES.
Posted on line recently is the submissions for the recent Medicare hearing where hearings filed and gone missing over the last several years, miraculously showed up in a hearing request from decision letters sent with Social Security letterhead and could not been done by them so they really were not a reconsideration as we do them where legal issues are addressed and other sources accessed, or development and/or all legal issues answered in some matter, etc. Govt contractors do not have the authority to do much beyond if the math was done right and service provided used the code for that particular one.
So hearing judges are now getting what used to be handled at the initial levels in side the agencies and attorneys are being begged to step in all over and most cannot afford those. Even they are finding decisions defied, also.
Today I got a call from a new center set up in Ohio where all the Medicare hearing requests are being sent. I have no idea is this is an ACS or govt facilaity as the caller ID seemed to indicate it was not govt at all? I filed with the appellate Judges for the Medicare hearings ones in file but ignored to get a remand back to hold he hearings that have never been held on premiums and other matters. never addressed legally at any level yet. SSA should not be sending out letters and taking appeals on premium issues if their judges will not get the requests and they do no do the lower level appeals. And then have appeals entered on the system and them disappear rather than show a transfer to CMS if that is where they are going and where! Even if not a paper file, the system still must show who has 'legal custody' of the data to be worked.
We did better with people and paper in the past in not losing track of a file and where it was. now with systems programmed without the needed security protocols to block any deletions, etc. no one knows what is going on at Medicare or at SSA. This is considered hacking by govt IT people.
So a request faxed to Appellate Medicare Judges ended up in the hearings office center for CMS. No judges had ordered a remand for those yet , If they wish to do them , fine.
I spoke to several at that center to day. Ans my personal opinion of all of them is they are 'OVERWHELMED BY THE CHAOS.. one office has been asked to sort out all of this for the nation. THEY NEED OUR PRAYERS AND /OR GOOD THOUGHTS. For files, we need something like pdf additions to agency internal sites. so that all the documents and answers do not go missing. and to have an appeal on the system , still does not clearly show what was the issues and the outcome. That is horrible for all.
And the head of neither SSA nor CMS is doing what is needed to be done to end the chaos. as all needs some clear guidelines as to who does what and where it all goes.
Why didn't we get an answer from Judge Engleman as to why he was sent all the hearings pending some as far back as 8.09 when SSA and Medicare issues got split and the file itself went missing until we reconstructed it for the recent hearing but the judge did not address it at all nor the other hearings in files that happened due to the first one not heard., by either SSA nor Medicare.on various premium matters and not rule on all of those? He did not answer that in the dismissal on the one issue that had already been resolved and I just had to send in a premium payment that is more than the law says I should pay and I contend is a double payment on top of that.
There is very little of all the appeals filed with regard to Medicare of any part that should ever have needed to go to a hearing. If appeals were done as we used to do them and real government officials did, with files in tact in one form or another. Then these would have been corrected and ACS et al would not be causing us so much trouble with getting medical care etc..... and medical bill collectors hounding me from bills not paid with more health care coverage than 100% on top of that.
I pray to Yahusha whom we Christians call Christ Jesus that this office is able to bring organizing out of a chaos created due to no one doing any real internal audit for over a decade to make sure all are following the same policies and procedures and correct those that cause chaos and problems for all.
For those of other faiths ask for help for all of us or if no faith think good thoughts as OUR MEDICAL CARE SUSTAINS OUR LIVES. and chaos in that is does not foster a good outcome many times.
In a few days, a new coding system starts to show what our ailments are and typos can cause more chaos and with all these government officials and government partners not under the HIPPAA law, there is no way to get errors , intentional or unintentional corrected.
Special big money interests have no place in health care. Fair income for services and products is part of the FREE MARKET SYSTEM. But we have created costs that do not need to be there over all of this chaos and worse is the 'crooks;' got inside and are helping themselves to our precious health care dollars. that should be used to pay for the direct medical care/. And past and current Congresses will not give any budget to make sure in the chaos the 'bad guys' now inside are not permitted to continue hacking in to systems and helping them selves. or getting out of paying the bills they are to pay and doing an 'illegal; dump' onto Medicare which. is needed for those who do have it as their primary health plan.
NO HEALTH PLAN WILL WORK FOR US, UNLESS WE STOP THE INTERNAL CHAOS AND THEFTS. AND ILLEGAL ACTS. Something that was in place with oversight and a federal 'police; to take care of those committing real crimes. ;from 'inside' and we stopped those few scam artist providers before they ran off with hundreds of millions of dollars , too as govt contractors who pay the claims hire good people who can be trained to keep an eye out for things that do not 'look right; so when they are not, then the legal system can take over and stop the outside thefts.
All of out good doctors and others who take care of our health needs deserve better than having their pay cut to offset thefts, this chaos is allowing to occur.And often the chaos appears to be intentionally created as the hacking in to the billing system in defiance of govt contract terms to block if one tries to alter when a posting comes in from employers and agencies. If its thought to be wrong, then they need to report it for the feds to investigate and stop it. But with that now contacted out to the same international cabal entity, we NEED A CONGRESS THAT WILL START REPRESENTING US AND TAKING CARE OUR BUSINESS.
Vote and try to find out who is trying up against great odds on these issues and rehire them and as for the others. "YOU'RE FIRED" Let someone else try to represent us , instead.
Now need to resent a first level appeal to Novatis and try to get them to do it and give one and answer the legal issues raised. The one filed a couple of months ago ended up at the 1-800 Medicare (General Dynamics) call center to have them 'train me' and I consider it a physical hardship to not have a government that sees that the contractors know what they are even suppose to do. instead of doing their job and sending it back to Novatis to do the redetermination appeal. and give me my constitutional appeal rights with a letter if I did not agree, they sent me what hey had been sent by them. That high school civics lesson seems to be forgotten in all of this for all of us.
Changing contractors may have stopped every claim of mine being debited 17 times from the Medicare TRUST FUND AND WE STILL DO NOT KNOW WHAT THE FEDERAL RESERVE DID WITH THE 16 EXTRA PAYS FOR 1/1/06 THROUGH 11/12?
I have to redo a mountain of paper work over and over. Something only a billionaire could afford the legal help to do in a neat , tidy, legalized way. And is not required for any of that to have to be done at agency level so all have access to justice , even if they have money for an attorney as we do not. Its why at the lower appeal levels we need clear answers to issues raised and legal citations, so should it need to go on to US District court, then its is ready for an attorney to not have to start at the beginning and be able to go forward, there is only one case that might end up going there, the math on the GPO offset, I if never had judicial review and it appears it was changed by the contractor programmer years ago and never questioned since and none at SSA ot Medicare has any idea, any more it just what the system does.) but not the offset itself as possible class action. Everything else should have been handled long before that level if each level would do the job they used to be able to do with clear guidelines and policies to follow , etc. And even know what the rules and laws are and what judges have said.
One of the spiritual gifts in Ephesians 4:11 of the Bible. is general common wisdom if one just wishes to call it an aptitude or talent. Its called administration. It a position, of humility, where one has a talent to take the laws or rules given to them by those in charge of a govt or institution or company and then sees to it the jobs get down, Without these kinds of people permitted to carry on the will of their superiors and in govt for the people, then we are in CHAOS and LAWLESSNESS AS CROOKS TAKE ADVANTAGE WITH REAL HARM DONE TO EACH AND EVERY ONE OF US. WHEN ITS MONEY WE PUT TOGETHER COLLECTIVELY TO HELP EACH OTHER WHEN NEEDED . THAT IS DISAPPEARING.
Linda Joy Adams 9/23/15
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