Law requires doctors to file Medicare claims

September 18, 1990|By Robert A. Rosenblatt | Robert A. Rosenblatt,Los Angeles Times

The nation's 34 million Medicare beneficiaries are about to have a big burden lifted from their shoulders: They no longer will have to spend hours filling out complex -- and often confusing -- forms to get reimbursed for their doctor bills.

Starting this month, a new law will require physicians themselves to fill out the claim forms for Medicare payments.

The federal program will spend $41.9 billion this fiscal year to help pay medical bills for people over 65 and the disabled of all ages. It also will be limiting physicians' fees for all Medicare patients. Starting in January, doctors will not be permitted to charge patients more than 25 percent above Medicare's recommended fee schedules.

But the new program may prove a mixed blessing for some recipients. It gives physicians up to a year to turn in the forms. As a result, patients now may have to wait months -- possibly as long as a year -- to get their reimbursement checks from Medicare.

Officials at the Health Care Financing Administration are fairly confident that most physicians, already experienced in dealing with Medicare paperwork, will file the forms promptly.

But Kathleen Vallee, regional coordinator for the Los Angeles Medicare Advocacy Project, one of 24 programs run by California's Health Insurance Advocacy and Counseling Program, is not as sanguine.

With penalties for late filing unusually light, there is little incentive for physicians to send their forms in very frequently, Ms. Vallee said. "A doctor could decide he does not want to hire another bookkeeper and could let the bills pile up in the back room," she said.

Still, Ms. Vallee said, the previous system had its flaws as well.

Some older people, puzzled about what Medicare will cover and intimidated by the forms, have neglected to fill out the papers. Beneficiaries lose between $90 million and $130 million a year on Medicare claims they never file, according to a 1989 government survey.

"We've had hundreds of frustrated people come in with paper bags filled with bills and Medicare forms, and say: 'Please help me,'" Ms. Vallee said.

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