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Organizing Records
I would like to address the subject of employer or union retirement
health plans. These plans vary -- they may include insurance similar to
a standard Medigap policy or a secondary
insurer having special rules before payments can be made to the
beneficiary or provider. It is difficult to track the paperwork of the
latter (secondary payer) plan because these plans generally have a
higher deductible before co-insurance payments "kick in", and
the payments may be 80% of the co-insurance amount; and once the
company's qualifying medical coverage amount is reached, the
co-insurance is paid in full. An
insurance claims record kept by the insured is especially suited for
this situation and would be an aid to tracking of bills and claims. In
the next segment (09) I will note the counseling assistance available
to Medicare beneficiaries, which includes the use of the insurance
claims record.
On the other hand, the Medicare beneficiary with standard Medigap insurance, or without any supplementary
insurance, can create a file as a tool to monitor claims and
payments. Organizing such a
Medicare file -- Medicare MSNs, Medigap EOBs and related
documents has always represented a challenge. Filing by date of service, using the
month containing most of the services listed on the MSN or EOB, appeared
to work the best – work the best prior to 2006
But in 2006-2007
the challenge has become greater.
Instead of monthly Medicare Summary Notices (MSNs),
beneficiaries in New York City have been receiving MSNs,
with a few exceptions, covering claims processed during a 60-90 day
period. And in the fall of 2007,
the Centers for Medicare & Medicaid Services (CMS) announced
effective October 29, 2007, MSNs will be
mailed on a quarterly basis. Since
the timing of submission of claims and elapsed time of claim processing
varies, those documents may include service dates of five or more
different months, and by multi-providers. How would such a file
work? Filing by date of service
is now out of the question.
There appears to be one choice – the filing of all
documents must follow the processing sequence of the MSNs.
Searching for particular documents will be a daunting job, but
it will be very important to your control of the claim and payment
process.
Six years ago
I described a procedure for correlating the various documents (MSN, EOB
and possible invoice) for each medical service, and closing out each
case. I have since discontinued
that procedure because all the medical services on a Medicare MSN and Medigap EOB usually do not dovetail with each
other. The correlating process
has now become even more arduous with the new quarterly MSNs. The
public and officialdom seem to have no knowledge of the “nitty gritty detail work” Medicare
beneficiaries are faced with -- many already involved in problematic
situations, medical or otherwise.
Therefore, I
suggested that the beneficiary correlate the MSN and EOB only for the
situations mentioned below.
Since there will usually be other services on those documents,
the correlation process then simply involves making an extra copy of
those documents for each service under review.
The
beneficiaries should compare copies of the MSN and EOB with a
provider’s invoice requesting payment of balance due, to check
for accuracy. Another type of
case is when an invoice has been paid in full at time of visit, and a
comparison with the MSN and EOB can prove whether the insured was
properly reimbursed.
I have
attempted in the previous three web site segments, 05, 06, and 07 to present
the information and methodology to help you do the above type of
checking. And if the bill
demanding payment, or insurance reimbursement, still doesn’t make
sense, click on to the next segment for help.
Updated:
January 14, 2008
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