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where you can get quick tips on how to prevent Medicare scams.
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 Why Do I Receive Medicare Summary Notices with Very Old Dates?
Medicare beneficiaries often ask the SMP program why Medicare Summary Notices seem so late sometimes, showing dates that are 12 – 18 months in the past. Medicare allows health care providers at least 15 months to submit their claims. And remember, Medicare sends your summary notice only once every three months. This is the reason keeping a medical calendar or journal of all your doctor and hospital visits and test dates can help you verify that Medicare has paid for a service you actually had. You should keep your list of visits for about two years so you can verify the accuracy of Medicare notices that come many months later.
SMP can give you a “personal health care journal” to help you keep track of your medical services and news or instructions that your doctor gives you. We’ll be happy to send you one if you call us at 1-800-423-2449.
Here’s some other information about your Medicare notices. You may notice that you receive them more often than every three months. Doctors’ charges and outpatient charges come from one claims processing office. Medical equipment and home health care come from other processing offices. Charges while you are an inpatient in the hospital also are mailed separately. All these offices mail their own Medicare notices.
There’s yet another reason you may receive old Medicare notices; it has to do with something new occurring in 2010. The health care reform legislation pending in Congress may affect some claims processing. Some rules regarding the maximum number of physical, occupational or speech therapy sessions covered during a calendar year, expired December 31, 2009. Congress may decide to change nothing and keep the same rules. Some claims may be delayed until Congress makes a final decision. This delay may also affect claims for some laboratory services.
Understanding Your Medicare Summary Notice
When Your Doctor is Part of a Hospital Owned Clinic
SMP advised you to look for errors in Medicare payments and we often give the example of Medicare paying for the same service twice. How many times have you heard there’s an “exception to the rule?” Here’s another one!
Hospitals that own physician practices and outpatient clinics and which meet specific Medicare regulations, may send Medicare two claims, each time you receive services from one of their physicians. One claim is submitted for the professional services of the doctor. The second claim is submitted for the “facility charge;” these charges represent the cost of office space and medical equipment and supplies that are provided by the hospital, for the physician’s use while treating or examining you.
Let’s consider an example of what your Medicare Summary Notices would look like. Your doctor works for XYZ Clinic which is owned and operated by XYZ Hospital. You see your doctor on Oct. 30, 2009 for a routine visit to check on your heart condition. You are covered by the traditional Medicare (not a Medicare Advantage plan) and in this example, your doctor accepts assignment of the Medicare payment for the services.
• One Medicare Summary Notice is for “Part B Medical Insurance – Assigned Claims” and shows the name of XYZ Hospital and your doctor’s name for an office/outpatient visit on Oct. 30.
• Second Medicare Summary Notice is for “Part B Medical Insurance – Outpatient Facility Claims” and shows the name of XYZ Hospital and your doctor’s name and also states charges for office/outpatient visit on Oct. 30.
If your doctor is part of a system that has “provider based” status with Medicare, payment can be made on both of these claims. If you are receiving two Medicare Summary notices for each doctor visit and you are not sure that your doctor’s office has “provider based” status, you should call your doctor’s office to ask. This helps assure you that Medicare is making correct payments for your healthcare and that money is not being lost on incorrect payments. You may also be interested to know that the U.S. Department of Health and Human Services Office of Inspector General is studying this Medicare regulation to determine if it costs beneficiaries and the Medicare program more than is appropriate.
If you ask for information from your doctor or hospital and cannot obtain all the information you need, you can call SMP at 1-800-423-2449.
An effort to help prevent medical identity theft is one part of the Obama Administration’s work to crack down on Medicare fraud. Attorney General Eric Holder and Secretary Kathleen Sebelius announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud. The HEAT team includes senior officials from DOJ and HHS.
A new tips and a printable brochure have been produced by the HHS Office of the Inspector General (OIG) and are available now at www.StopMedicareFraud.gov and www.oig.hhs.gov/fraud/idtheft.
Blank Checks from your Credit Card Company can be Risky
A recent issue of “FDIC Consumer News” (Spring, 2009) highlights the risks of using blank checks, sometimes called “convenience checks” sent by your credit card company.
First and foremost, be certain you understand all the fees and interest charges you will pay if you use the checks.
Secondly, there are dangers for these checks could be stolen or taken from you and used against your credit card.
• If you throw away the checks without shredding or destroying them, thieves may rummage through trash at your home or at the landfill to fish them out.
• Other people in your home or visitors to your home (for instance home aides or repair workers) could take these checks and use them against your account.
Consider asking the credit card issuer to stop mailing the convenience checks if you are certain you don’t want to use them. SMP contacted one large credit union which issues these checks to their credit card customers and we were told they would be able to assist a customer who didn’t wish to use such checks.
$250 Economic Recovery Payments to Arrive May, 2009
If you are receiving a Social Security, SSI, Railroad Retirement or Veterans benefits now, you’ll receive a special, one- time $250 payment by the end of May. If you receive your monthly benefits by direct deposit, the $250 will come to your bank account or if you receive a check in the mail each month, the $250 will be sent in a check.
We expect scam artists will jump on this opportunity to defraud retired people. If they contact you they’ll try to convince you that in order to receive the money, you have to give out your personal information, including your bank account information.
• Don’t talk to anyone calling on the phone, asking for your personal information.
• Don’t respond to any letters that ask you to write down your personal information and send it in. You will get a letter from the government telling you the payment is coming, but you do not have to respond to the letter.
• Don’t respond to any e-mail sent to you, asking you to click on a link to provide information.
If you have friends or family who are nursing home residents, please note that they will receive this payment as well, unless their only income is the limited $30 SSI payment or if they live in a government –owned facility. If you need more information you can contact your local Social Security office or look at the Social Security website in the “Economic Recovery One-time Payments” section.
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