Sunday, December 17, 2017
Health

Medicare billing statements simplified to fight fraud

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass.

The new, more consumer-friendly format, which goes online Saturday on Medicare's secure website, www.mymedi care.gov, includes larger type and explanations of medical services in plain English. The revised paper version, which is mailed to seniors every three months, will be phased in early next year.

"You can make a difference!" the revamped statement says. "Last year Medicare saved taxpayers $4 billion — the largest sum ever reported in a single year thanks to people who reported suspicious activity to Medicare."

The new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud. Although the bonus isn't new, there's no mention of it on current forms, which are sent to about 36 million beneficiaries in traditional Medicare.

"We approached this redesign from the standpoint of making it a more consumer-friendly document for beneficiaries and also a better fraud-fighting tool," said Erin Pressley, director of creative services for the Centers for Medicare and Medicaid Services. "If they are paying attention to these documents, they are going to be the best defense we have."

"It shouldn't be a scavenger hunt," she added.

Currently, Medicare summary notices, as the billing statements are called, can run more than a dozen pages for those with multiple doctor visits and treatments and are full of medical jargon and abbreviations that often read like a secret code.

Filing an appeal if a claim is denied will also be easier. The new form explains what to do for those who disagree with a payment decision and how to get help filing an appeal, and it offers a form that can be filled in and mailed. Beneficiaries can also check the status of claims online and then use the online appeals form instead of waiting to receive their statement in the mail.

Expediting the process is important because many seniors can't afford to pay for nursing-home care or other expensive medical bills and may go without the care they need, said Leslie Fried, Medicare advocacy director for the Alzheimer's Association.

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