|
|
Review Invoices Carefully
I believe on the basis of these last sixteen years of counseling that
too many Medicare beneficiaries do not review their invoices carefully.
One of the precautions is that you simply compare the medical provider
invoice with the Medicare Summary Notice. A tip: a New York State
Surcharge (Tax) item on the invoice means that the provider does not
know you are a Medicare beneficiary because billings to Medicare are
exempt from the surcharge. Therefore, call the provider and submit your
Medicare number. This happens sometimes on emergency ambulance and lab
bills. About 90% of the New York
downstate area Medicare claims are assignment, so all the illustrated
cases will be assignment claims. We will do the "side by
side" comparison of the MSN and an emergency outpatient (always
assignment) bill in the first two of the following four cases, and the
third and fourth illustrations will be physicians’ bills.
Basically, as in a bank reconciliation (bank balance vs. checkbook
balance) of our personal accounts, we are comparing the invoice amount
for a particular service (date) from the medical provider and the total
amount in the "You May Be Billed" column of the MSN Notice
for that service.
Before going
on to the first two of four cases of side by side comparison of invoice
and Medicare MSN I must remind you, as I did in the last segment, you
may not have the MSN available at the time you are examining the
medical provider’s invoice request for payment. I advised then that we would need to
request (with the help of provider’s name and date of service) a
copy of the MSN. I suggest one
of the following two methods to obtain a copy:
1) Call 1-800-Medicare
(1-800-5333-4227), and you will be given a choice of subjects for
inquiry. Select billing. You will be connected to the contractor
who issues MSNs in your region for a copy.
2) Register on http://my.medicare.gov,
and you will be mailed a one-time password. Together with your Medicare Number
sign in to My.Medicare.gov to choose your new password. You will now be enabled to use
my.medicare.gov to order a duplicate Medicare Summary Notice and many
other services, including replacement Medicare card, view claim status
(excluding Part D claims), access online forms and publications, etc.
In the first case the balances of the MSN and hospital outpatient bill
agree, but we must also make certain that the services were recorded
accurately before signing off on a true reconciliation; and in this
particular case double postings were found on the hospital outpatient
bill. This error should be corrected, which will result in a refund to
Medicare and a decrease in the balance due from you (or your Medigap
insurer). These types of errors are not uncommon on hospital outpatient
bills, due to the very large volume of posted transactions processed by
hospital accounting departments.
The second
case illustrates a more difficult problem because the balance of a two
page emergency visit (not uncommon for "us seniors") bill
does not agree with the MSN “You May Be Billed" figure. Furthermore, the Medicare payments
and Medicare allowance adjustments have not been matched against the
charges on the invoice. The MSN is of no help because it contains two
lines of description. This is a true case history. You should first
look at the invoice as best you can (considering you were in an
emergency situation) for any apparent discrepancies in services
charged. Let us assume the invoice appears proper. Your next call is to the hospital
Customer Service Department. You need to remember one fact--the
Medicare beneficiary is responsible for co-payments which vary
according to service, but on items approved and partially paid by
Medicare. In order to accomplish
this type of analysis, the hospital should post the Medicare payments
and allowances against the appropriate charges, as well as notations of
Medicare rejected services, and verify that the total of Medicare
payments agrees with the amount stated on the MSN. At this point, it is expected that
your account is in order -- the details support the MSN “You May
Be Billed” amount.
In the case
of a doctor's bill, we would follow basically the same procedure. As in
the case of the outpatient bills, even though the MSN balance and the
physician's invoice balance agree, you should examine the details of
both documents. In this first physician case, the MSN "You May Be
Billed" column could include items such as co-insurance, $135
deductible or part of it, non covered items such as eye refraction and
routine physical exam, or a rejected service for which there was lack
of supporting information, and the patient was informed in writing
before receiving the service that Medicare would not pay. Two items may
strike you immediately: you paid the deductible and it wasn't credited on
your bill; and the rejected service was supported by your past medical
history and had been paid previously by Medicare over a period of time.
Both of the above matters should be explained to the biller. In the second instance, the biller
could arrange for the resubmission of the Medicare claim by the doctor.
In the second
doctor bill example there is a difference in the MSN and invoice
balance, and the information on both documents appears to be correct.
There could be a bookkeeping posting error along these lines -- the
originally posted "actual" (doctor's) charge differs from the
Medicare-approved amount. Upon the receipt of 80% of the Medicare
approved amount, the bookkeeper omits posting the "Medicare
Allowance" (difference between actual charge and Medicare-
approved charge), resulting in an incorrect invoice balance. That type
of error should again, of course, be brought to the attention of the
biller.
Updated:
January 14, 2008
|
