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Whisper's Medicare Updates.
One of the most difficult things to understand
today is the Medicare/Medicaid Benefits. We will try to keep you updated on the
changes that come about and if you have specific questions you would like
answered, just let us know. We will endeavor to answer any questions you may
have and if we do not know the answer will attempt to find the answer for you.
For this time the words
Medicare Fraud and
Abuse come to mind as
it is so much in the news today. So we will explain the differences and what you
can do about them, in this way we can maybe protect Medicare for our children.
The most important thing here is when you
receive your statement from Medicare as to what they paid for, be sure to check
this carefully. This is called your EOMB (explanation of Medicare
benefits)
FRAUD
This is when there has been a deliberate
deception or misrepresentation of what has been done for you. This could be by a
supplier, Physician, or hospital etc. In some cases it could even be an
error in entry. Someone inexperienced at the place of care punching in a code
with like charges because they could not find the correct code to begin with.
Never the less you should be able to account for everything on this EOMB.Fraud
includes:
- Billing for services not provided. Such as
medications, X-rays, blood tests, treatments, etc.
- Falsely representing the nature of the
service provided, such as the hospital bill showing you went through the
Emergency room and you actually were admitted directly into the hospital. The
charges could be similar, but not documented properly.
- Or changing the date of service.
ABUSE
There are similarly many ways to abuse the
system:
- Charging an unreasonable amount for services
or supplies
- Submitting services that are unnecessary
- Billing both you and Medicare for the same
services.
If you feel you have come across some of these
situations, after reviewing you EOMB, you can call the Govt directly toll free
at
1(800)447-8477 Mon-Fri 9am-9pm EST.
Differences in Coverage;
This is very confusing for some but will
attempt to explain the differences.
Parts A helps pay for hospital and facility
charges such as your room, inpatient medications and equipment. Parts B on the
other hand pays such services as the Drs services, ambulance services and lab
fees (when not done in the hospital setting), equipment and supplies.
These are handled by two different offices and
neither has access to the others records. If you have a question on your parts A
billing you must contact the hospital where the services were performed to find
out which office they used for the Parts A assignment as many states have 2 or
more offices that handle the Parts A assignments.
You must
have your Medicare number ready when calling any Medicare office.
If you have lost your card with your Medicare
number, contact the Social Security office at :
1(800)772-1213 for a
replacement.card
 Information
about RX with Parts D
Copyright © 1997
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Last modified:
March 28, 2006
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