Linda Joy Adams: Search results for conditional payment this is a link to prior posts;
Last week, Novatis a Medicare claims payer finally found out and told medical billers how to legally get paid by Medicare when the primary payers do not pay... A procedure that the taxpayers have paid to have programmed into existing billing software , but has not been included since 1/06... which resulted in all kinds of illegal processes being set up and hacking by the contractor that owns the system.. the Common working file... Emblem Health International .. who is prohibited by law and contact with Centers for Medicare and Medicaid Services not to alter the info posted by ones employer... Yet they continued to do so as NO ONE EVEN IN THE CURRENT GOVERNMENT KNEW HOW TO GET A CLAIM SUBMITTED LEGALLY UNDER THE CONDITIONAL PAYMENT LAW OF 1980.
If a claim is sent in and its known that someone else should have paid its Medicare fraud. UNLESS its filed as a conditional payments.. Horrendously for the taxpayer and every one else, the contractors have been using illegal software programs, phony claim numbers and convincing the owner to hack the system and alter the legal line up in violation of their contract.. And since this has been going on big time since the COUP of 2002. when Congress removed any budget for audits or criminal, investigations of the contractors, some insiders say its several trillion dollars that is owed back to Medicare that never got recovered from the primary payers.
The system now clearly identifies that ones employer is making the posting and I even got three Medicare Judges, who got the internal documents from the US Department of Labor which has official employment jurisdiction of me since 1094 that I am still active duty (not retired) and that the two primary payers of FECA and Fed Blues is accurate and Medicare is secondary .
The new system had stopped the hacking and medical billers were being sent in circles to get paid as Medicare was not the primary payer on the system... and NO ONE KNEW... AND I HAVE BEEN TRYING TO FIND OUT THE PROCESS SINCE THE SYSTEMS WERE PROGRAMMED WRONG IN 1/06 AND LEFT THE FIELD OFF "PRIMARY PAYER ISSUE' ETC.
The new system still does not meet the taxpayer specifications and blocks someone from altering the info and on last week a supervisor at Emblem Health International went in and hacked the system and defrauded the taxpayer... while Novatis the primary claims payer for this area, had already got the process located. A PAPER CLAIM,, which I knew all had to be allowed to do by he laws o the land when the government did not have a way to file electronically.. Hopefully this will get corrected... as this is trillions of dollars in claims that need to be listed for new injury cases, to recovery when approved.. or LIKE IN MY CASE WHEN THE PRIMARIES WILL NOT PAY THERE already legally obligated bill. as they are too financially connected to the liability insurer for the owner of the building where I was injured on the job 1/10/89..
HOMELAND SECURITY IS NOW INVOLVED IN OVERSEEING CYBER INSECURITY AND ALL NEED TO BE AWARE THAT ITS PAST TIME TO FUDGE THE SYSTEM AND STEAL... AS ITS PERFECTLY LEGAL TO HAVE MEDICARE PAY IF LABELED AS A CONDITIONAL [PAYMENT AND THEN NEITHER THE PATIENT NOR THE MEDICAL PROVIDERS, SUPPLIER OR PHARMACIST IS OVERPAID... If the government chooses not to collect money owed back by the primary payers, then the patients and medical providers are NOT AT ANY LEGAL RISK... we have done our part.. to clearly identify that Medicare is asked to pay as the liable ones will not.
HOW TO GET PAID BY MEDICARE UNDER THE CONDITIONAL PAYMENT LAW OF 1980
The process is not as bad as one has been made to think...
1. call Affiliated computer Services call center for Federal Workers Comp phone number: 1-866-335-8319; Fax for filing a medical bill..1-800-215-4901 case number 020600326 Date of injury 1/10/89 where I have 100% total coverage and permanent (life) (due to home oxygen under an obscure 1988 labor law... that few are even aware of.. but the system that posts to the common working file at Medicare is well aware of it.. and very accurate and secure. as its a government owned system .. at US Department of Labor. and you will be misinformed that my case is inactive. and they will give you a confirmation number for the call to confirm you checked.. IT IS REASONABLE TO ASSUME THAT THEY WILL NOT PAY THE CLAIM until the real government is allowed to enforce its laws by Congress putting the budget back to enforce its own judges orders to get my file posted from my records and pay, process. etc.. The contractor has ignored this order and is the same entity behind a cabal of companies that has control of all three of my health plans. If you do file a claim they will use a dummy system or one of the ones they use for everyone else's workers compensation carriers and it will not be paid... and appeals are ignored since 2002.. The rules for CMS are that you do file.... and its done by paper and the template is online under FECA &Federal Employees Compensation Act.
MEDICARE HAS A CLAUSE OF EITHER WAITING 4 MONTHS OR LESS IF REASONABLE TO ASSUME NOTHING WILL BE PAID.. The phone call makes it reasonable and past bad actions since 2002 does also. No one in the Regional office for FECA has access to my files or records at all to know what is going on as the contractor will not permit it. DO NOT WAIT AND GO ON TO FED BLUES
2. Bill federal Blue Cross Blue Shield and they will kick it back saying that their management company which is the same one for the other plans of mine... have determined that Medicare is the primary payer... and they also have been the ones calling Emblem Health and making up fake retirement dates on me... at least 4 I know of .. since 2002. this usually takes about a week or less to get word back..
3 NOW YOU CAN GO TO MEDICARE... AND THIS IS THE PROCESS SUPPLIED BY NOVATIS THE INTERMEDIARY .. FOR MOST CLAIMS.
A. go on medicare .gov and go to COMPLIANCE AND ASK FOR A WAIVER TO DO A PAPER CLAIM.... DUE TO PRIMARY PAYERS WILL NOT PAY AND NO WAY TO ELECTRONICALLY BILL. as system has no field to ask for it.
B. Medicare should pay the claim timely and then
C, . send the response back to Federal Blues for the co pays... or whatever Medicare did not pay as there is 100% coverage between the two. and they are to send to their medical subrogation so they can then send a recovery letter to FECA>...something they have not done since Lynn Blodgett's nearly 200 companies took over management of them also.. .
D. wait for Congress to put budget back to enforce its laws. and then get an additional amount owed at the employed rate at Fed Blues which is the law for all workers comp to end up paid what the employer group health plan pays.. FEW medical providers HAVE GOTTEN ANY OF THIS PAY EITHER..
Instead of going on circles for months, or putting all at legal risk by fudging and getting paid illegally by Medicare... this process should only take a couple of weeks longer than usually when there is no issue.. ALL THE HASSLES ARE ENDED... AND THE WORRY IS GONE AS THE GOVERNMENT HAS TO ENFORCE ITS LAWS... THERE IS NO WAY THE PATIENTS OR THE PROVIDER CAN DO SO...
I have 38 federal agency judges in multiple agencies defied.. and they have no authority to act.against their own agency contractors. .. and neither did the Director of Federal workers comp and a former Secretary of Labor, who intervened on my behalf to obey their own judges and disappeared the file and defied her..
So do not expect me to straighten out the whole corrupted SWAMP IN DC.. that has gotten worse and worse over the years since the COUP of 2002... when most of Congress did not even know what they voted for.... in the e governing laws. Most in the real governed did not know until Fall of 2008 that it was Congress and not the political heads of agencies just not wishing a 'scandal" as to why the laws were being ignored as Medicare got robbed and everyone's payments went down to make up for the theft losses. as all were being told that this is the way its done and it never was. since 1980.
I have been in this area of work since 1968 first as government employee and also as a patient and have conducted Medicare fraud investigation and signed orders to insurance companies that were referred to the US Attorney for collection. etc. who have done far less that has been going on since 2002.
And its been since 1994, that the Conditional payment law was enforced and whys its called the recovery unit and not the collection unit.. So how are we as patients and providers to do what the real government still cannot do... all I have every asked is to not get me over paid, and I wish none of my good doctors, etc. to be so either.
My prayers to Yahusha whom we Christians call Christ Jesus is not congress will do their job and restore the right to use some of the existing budget to enforcee the laws. of the land.. as this is not just in health care this has gone on..
Linda Joy Adams 10/28/16
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Medical billings personnel have indicated that a claim should be filed with FECA just to protect the filing date. Go to ACS Bill Portal for FECA and there is a fax template to fax to 1-800-215-4901 But one should not expect any payment until Congress enforces its laws again since the COUP OF 2002.. The law does not require months wait for an answer as it says what is reasonable .. And its reasonable not to wait and go ahead and bill Medicare as a conditional payment after Federal Blues management. send it back to send to Medicare. This should not take more than about 10 extra business days for payment from Medicare and will avoid the months that some have gone through trying to get any kind of payment at all. Its reasonable to assume no FECA payment until Congress puts back budget oversight removed in the OCUP of 2002 when laws can against be enforced against its own contractors. As my file has not even been set up even though it is an established case since 1/10/1989 and have permanent medical already for nearly 22 years under an obscure 1988 Labor law when I was put-on home liquid or compressed air oxygen for life which also due to it being oxygen that awarded this, makes 100% of all medical bills FECA's at the contractor. few understand this law and even fewer oxygen suppliers when they get a reject from the Medicare system for having primary payers if its not visible on the billing screen for Medicare which it may not be with the melt down of the system and what the clearing houses are sending on to the suppliers and medical providers and pharmacies now is absolute garbage at times. No one at the real US Department of Labor has any idea what is going on as the contractor will not post my file as judges have now ordered using my records to do so and I am waiting for years to responses to my follow ups with them to set up a process to get it done as I am do years of out of pocket expenses to be reimbursed and other medical suppliers etc. have also waited years for payment. They may send a kind of dummy file response, but it is not through their real system at all as they requires them to input over 15 years of oxygen invoices timely files and pending since the ACS took over medical care control in the USA with their shell companies and illegal secret dal partnerships in the COUP of 2002. Welcome to the "SWAMP TO BE DRAINED" the whole nation has been adversely affected by especially in heath care and getting fair and timely payment for it .Linda Joy Adams 11/30/16
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