Managing Medicare Costs Starts with Verifying Charges, Says Allsup

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Allsup outlines steps people can take to make sure they don’t overpay for healthcare services.

It’s important to be an active participant in your healthcare, and this includes understanding the cost of your care.

While people relying on Medicare can’t control the rising costs of healthcare services, they can do more to make sure they only pay for the healthcare services they use, according to Allsup, a nationwide provider of Medicare plan selection services and Social Security disability representation.

“It’s important to be an active participant in your healthcare, and this includes understanding the cost of your care,” said Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor®. The Allsup Medicare Advisor is an impartial Medicare plan selection service that helps people understand and choose the most affordable and appropriate Medicare coverage for their healthcare needs. (Allsup is not a Medicare plan provider and does not accept commissions from insurance providers.)

According to a report by the Centers for Medicare & Medicaid Services, the error rate for original Medicare (fee-for-service) was about 10.5 percent in 2010, accounting for $34.3 billion in improper payments by Medicare. The error rate was 14.1 percent for Medicare Advantage plans, resulting in $13.6 billion in improper payments. While not an indicator of fraud, Medicare considers errors to include duplicate payments, incorrect coding of services and insufficient documentation. However, this only includes the cost to Medicare, not the amount that Medicare beneficiaries may be paying out of their own pockets for mistakes.

At least $68 billion is lost to healthcare fraud, according to estimates by the National Health Care Anti-Fraud Association (NHCAA), which notes this represents 3 percent of all healthcare spending.

Steps For Protecting Against Medicare Billing Errors

Medicare beneficiaries can take steps to minimize their chance of paying for billing errors, said Muralidharan, including:

1.    Ask about costs beforehand. If you know about a procedure you need to have done in advance, ask your doctor or the healthcare facility about the costs involved. Also, verify with Medicare or your insurance provider the amount they will cover and what will be charged to you. Additionally, if you are able, keep track of the tests, medications and other care you receive and when you receive it. If you’re not able to do this yourself, ask a friend or family member for help.

2.    Review your Medicare Summary Notice (MSN) and/or Explanation of Benefits (EOB). If you have traditional Medicare, you will receive a MSN. You will receive an EOB if you have a Medicare Advantage plan or Medicare Part D prescription drug plan. These documents tell you what your insurance covers and what costs the provider can bill to you.

3.    Review each bill for accuracy. If you inquired about costs of a procedure beforehand, compare this information with what you are billed. Also compare bills to your MSN or EOB. Errors include being billed more than once for the same test or procedure and being billed for tests or procedures you never received. Additional errors in the time, date or duration of a procedure also can affect your costs. For example, some operating rooms charge different fees at different times; a few minutes difference in your admittance or discharge time can mean extra room charges.

4.    Notify healthcare providers of inaccuracies. If you spot an error, contact the doctor or other healthcare provider as soon as possible. Keep track of each person you spoke to, when and the outcome. If the healthcare provider is not able to resolve the issue for you in a timely fashion, you should notify Medicare or your insurance provider.

5.    File a grievance if the matter is not rectified. All Medicare beneficiaries can file grievances through the Quality Improvement Organization (QIO) in their state. Your grievance could be about payment, services or other problems related to receiving care. Those with Medicare Advantage or Medicare Part D plans also can file a grievance through their health insurance provider.

Allsup provides detail on how to contact Medicare and QIOs on its website at http://www.allsup.com/personal-finance/managing-healthcare-costs/medicare/report-medicare-errors-and-fraud.aspx.

6.    Consider changing your healthcare coverage if you’re unhappy with it. Medicare beneficiaries have options and shouldn’t be afraid to evaluate their provider when it comes to charges, the billing process and related concerns, Muralidharan said. Each year during annual enrollment Medicare beneficiaries are allowed to add, drop and change their Medicare plans. Annual enrollment runs from Oct. 15 to Dec. 7, 2011, for 2012 coverage. There also are special enrollment periods throughout the year for specific circumstances.

For an evaluation of your Medicare options or questions about switching providers, please call an Allsup Medicare Advisor specialist at (866) 521-7655 or go to http://medicare.allsup.com.

Protecting Against Fraud

Medicare beneficiaries also need to keep an eye out for Medicare fraud, Muralidharan said. Unlike errors that generally occur as a result of unintentional mistakes or oversights, fraud occurs when someone knowingly falsifies information.

Medicare beneficiaries who believe they have been a victim of fraud can contact the fraud hotline operated by the U.S. Department of Health & Human Services (HHS) Office of Inspector General. Allsup provides detail on reporting Medicare fraud on its website at http://www.allsup.com/personal-finance/managing-healthcare-costs/medicare/report-medicare-errors-and-fraud.aspx.

About Allsup
Allsup is a nationwide provider of Social Security disability, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs nearly 800 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis. For more information, visit http://www.Allsup.com.

The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.

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Mary Jung
for Allsup
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Rebecca Ray
Allsup
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