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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.
I had 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 have
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 25, 2010
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