Change in Medicare billing rules starts in April

Itemized bills required on request

Starting April 1, Medicare providers must issue itemized statements to Medicare beneficiaries who request them. The new rule, mandated by the Balanced Budget Act of 1997, is another part of the federal government’s campaign to actively involve Medicare seniors in fraud and abuse investigations by making it easier for them to identify incorrect or improper payments for services.

For Medicare Part A institutional providers in Alaska, Maine, New Hampshire, New Jersey, North Carolina, Vermont, and Washington state — and those served by fiscal intermediary Mutual of Omaha in any state — the new policy will take effect July 1, 1999.

Advisory statement to be printed on EOB

Pat Smith, a government affairs representative in the Medical Group Management Association’s Washington, DC, office, cites these key provisions of the new rules:

    • Medicare carriers and intermediaries on the Fiscal Intermediary Standard System will print a statement on the Explanation of Medicare Benefits and Medicare Summary Notices advising beneficiaries of their right to request an itemized statement from their providers.
    • Providers and suppliers are required to furnish itemized statements within 30 days when requested in writing by Medicare beneficiaries.
    • Providers may not charge beneficiaries for itemized statements.
    • Itemized statements must include the beneficiary’s name, the date of service, a description of the item or service furnished, the number of services provided, the provider/supplier charges, an internal reference or tracking number, and the name and telephone number of a person to contact for more information.

Medicare contractors have been directed to inform all providers and suppliers of this new requirement. The Health Care Financing Admini stration has notified Medicare contractors of the changes and asked them to reprint the information in their provider/supplier bulletins, plus post a notice on their electronic bulletin boards or Web sites as soon as possible.