Medicare overhauls patient claims statements

Program officials want beneficiaries to better understand their benefits and help smoke out potential fraud.

By — Posted March 15, 2012

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Medicare has redesigned the claims and benefits statements that are sent to enrollees on a quarterly basis, with the goal of clarifying a document that has been criticized as impenetrable to many patients.

Some of the changes to the Medicare summary notices include descriptions of medical services that are deemed more consumer-friendly, larger fonts and definitions of all the terms that Medicare uses on the forms. The notice also is reformatted around a snapshot of the beneficiary's current deductible status, a list of health professionals they saw during the quarter, and information about whether their claims were approved or denied.

Critics of the Medicare claims system have complained that beneficiaries often don't realize that claims for their services have been rejected, making the process of appealing those decisions more difficult. The Centers for Medicare & Medicaid Services said the clearer forms will make it easier for patients to launch appeals if they think the denials were unwarranted. Beneficiaries often require their physicians' help in lodging such challenges.

Marilyn Tavenner, CMS acting administrator, noted that the redesign announcement came during National Consumer Protection Week.

"Consumer protection starts with making sure consumers not only get timely and accurate information, but that they understand what services they're receiving from Medicare," she said. "The new Medicare Summary Notice empowers Medicare's seniors and people with disabilities. The statement is easier to understand and navigate and makes clear what information to check and how to report potential fraud."

Medicare officials urge beneficiaries to review their statements carefully to see if services were ordered that they do not recognize, or if unknown health professionals or suppliers filed claims listing them as the patients. Medicare makes tens of billions of dollars in improper payments annually, with fraudulent activity accounting for a portion of it.

Patients who check their Medicare information online at will be able to see the redesigned statements right away, but beneficiaries who receive the notices through the mail will not get their first updated form until early 2013. A side-by-side comparison of the old and new forms can be seen on the CMS website (link).

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