DOBSON — In an effort to protect the Medicare beneficiaries of North Carolina from fraud, waste and abuse, the Seniors’ Health Insurance Information Program (SHIIP) and the North Carolina Senior Medicare Patrol are encouraging all Medicare beneficiaries to read their Medicare Summary Notices.
“notices are sent so people know charges to their medicare,” said local SHIIP Coordinator Carmen Long. “Sadly I have had some tell me they never look at their notices and file them away. If they are not opened up they don’t know what has been charged to them.”
Long explained that notices are mailed to beneficiaries every three months for services covered by Medicare Part A and Part B. notices are not bills; they are a record of the services and supplies that providers and suppliers billed to Medicare, the amounts that Medicare paid and the amounts the beneficiary may owe the provider. It is vital that beneficiaries read and understand their notices to recognize possible Medicare fraud, billing errors and discrepancies.
The Centers for Medicare & Medicaid Services recently redesigned the notices in an effort to make them more user-friendly. The new design still contains the same important information for review.
She said one Medicare participant she had talked to read her notice and realized there were charges and physicians listed she had never visited. It turned out the charges came from a person whose name was identical to hers. If she had not called on the matter she would have been charged for those visits.
“It’s always a wise idea to check,” Long said. “Most of the times everything is correct on the MSN. Sometimes some doctors have an outside firm handle their collections and billing so there can be an address that is not the same as the actual practice patients visit. Part D of the MSN will tell what the provider was paid, how much Medicare covered and what the patient will be billed.”
Long encouraged participants to keep a medical journal, which can be as simple as writing the visits, treatments and doctors visited on a calendar to make double checking simple. She said areas to check for accuracy include name and address and the Medicare Claim Number.
The Part A MSN will provide information about inpatient hospital stays, skilled nursing facility rehab stays and home health visits following inpatient hospital stays and or skilled nursing facility rehab stays. This information will include dates of service, the name and address of the facility and the name of the referring physician. It also will show the number of covered benefit days and if Medicare covered those stays, non-covered charges, the amount Medicare paid the facility, and the maximum amount the provider can bill you or your secondary insurance for deductibles, coinsurance or non-covered charges.
The Part B MSN will provide information about claims from doctor services, diagnostic tests, equipment, and ambulance and other medical services. Each claim will have dates of service, the supplies received, and the name and address of the provider. The information will include if Medicare covered the service, the provider’s fee for the service, the amount a provider can be paid for the service, the amount paid to the provider by Medicare and the maximum amount you may be billed.
Seniors who believe they may have been a victim of fraud, waste or abuse, please contact the North Carolina Senior Medicare Patrol at 1-877-996-2767.
“If you have questions and think you may be a victim of fraud, The North Carolina Department of Insurance will help investigate. They have experts trained to figure out these situations. Because more than one person is a victim of fraud, speaking up on you own behalf often helps a lot of individuals.”
Reach David Broyles at firstname.lastname@example.org or 719-1952.