What was billed under my medicare number.?

Question

I am a physician working for a group. The head of the group does not let me see the billing or the re-embursment. He will not even allow me access to my own medicare number. I don't know which area of medicare to contact. Do you know the correct phone number or website to use so I can find out what was billed under my medicare number?

Answer 1

Usually I deal with consumer questions about Medicare. It sounds like you have some "office politics" going on where you work. I am making the assumption that you have attempted to engage your group's leader in a reasoned conversation about (what appear to me to be) your legitimate questions about how Medicare billing is handled in your office.

So, having said this, if I were you my goal would be to get the facts about Medicare billing. I am thinking that you might consider requesting information and guidance from someone in your state's Medicare Peer Review Organization (PRO). Every state has one of these organizations that review physician compliance with Medicare rules. The names of these organizations are going to be different from state to state. For political reasons, you might want to contact one of these organizations from a state that is different than yours and find a professional there who can provide you basic information you are seeking about Medicare billing practices--such as, is it proper for you, as a physician, to have access to your Medicare number and to review billed services? I suggest this because you want to find out all the facts--and as many nuances as you can-- before you raise "red flags" outside your office setting. As they say, "it's a small world after all!" If you talk with your state's PRO first, you may unintentionally trigger administrative consequences for your group --or for yourself--which might not be fun to deal with and could jeopardize your position.

Another idea would be to contact one of the regional offices of the Center for Medicare and Medicaid Services (CMS). There are 10 regional offices of the US Health and Human Services in the nation. Someone at one of these offices might be able to provide you guidance and information. I know there are offices located in Chicago, Kansas City, Denver and San Francisco. If you want to know this office number for the region serving where you live--or the name of your state's PRO-- the easiest thing might be to contact the office of your Congressional representative.

You also might try to call 1-800-Medicare. This number is used to assist Medicare Part D beneficiaries--I doubt that the persons answering the phone would have the information you would need--but it might be worth a try...

Do you have colleagues in other places--maybe out of state--that might be able to provide you advice and information about this? How do their practices handle Medicare billing? What would they do if they found themselves in your situation? Having conversations with fellow-physicians you trust concerning billing practices might be the absolute best place to start.

I hope these ideas help somehow. Good Luck and Best Wishes!

Answer 2

Embursment