Notes

I am appealing this decision because I have made numrous requests to the attending physicians office who ordered the MRI. I was made aware last summer by a telephone call to Medicare that the code was incorrect.
When I made the doctors office aware that the code was incorrect and needed to be changed I was told then that the code they used was incorrect, but contact with Medicare continued to tell me the code was incorrect, that it needed to be changed from routine to medically necessary. This leaves me in the middle, Medicare wants a new code and my doctors office says the code they used us correct. Now I am being held responsible for something that I have no control over. The $705 has been turned over to COLLECTIONS and I am being held responsible for something I have no control over.

I did a first appeal and was dismissed because the initial service is past the time limit of one year. I learned that yesterday from Medicare that my doctor's office can no longer attempt to make any changes due to time limits, and that my only option is for me to appeal.

I feel that I have good cause for payment request since I have had no control over this Medicare service. Filing late was not my responsibility, it was my doctor's office who has refused to acknowledge that the original code they filed was incorrect.

Now on April 1, I received denial of my appeal due to time limits. On April 5, I spoke with Medicaid and they too informed me that I have been denied due to time limits.
It's not fair that I am being held responsible for payment because my doctor's office did not comply with Medicare's request to refile to Medicare for the correct coding.