Good News for those on Medicare…but bad news for hospitals:  New Years Day Congress averted the dreaded “fiscal cliff” by stopping a 26.5% payment cut to doctors billing Medicare…but hospitals now having to bear a major part of financing for the “doc fix”, are not happy.

The bill would require that, over the next decade, hospitals to pick up half of the $30 billion cost of stopping the payment cut for Medicare physicians. Groups representing hospitals said the new plans for reductions will hurt hospitals ability to care for patients, as reported by Kaiser Health News.

Rich Umbdenstock, president and CEO of the American Hospital Association said, “While fixing the physician payment formula is essential, it should not be done by jeopardizing hospitals’ ability to care of seniors and their communities.”

HCN Readers Be Aware:  When you go home early from the hospital…You now know why!!!  There are more new rules from Healthcare Reform that will slowly be exposed…

Hi Toni:
I’m the granddaughter who attended your seminar at Sugar Creek in October.  This week I took my grandmother to see a neurologist and his office said that since Medicare is primary on her insurance, we would have to pay up front and be reimbursed by medicare. Can you please tell me what I need to do to submit this visit for reimbursement?

 Thank you so much –Susan…Fort Bend County resident

Hello Susan:

In these trying economic times that we are in and with all of the changes with Medicare, many doctors are not accepting Medicare and will not bill Medicare for you.  They want you to submit the bill to Medicare and wait to be reimbursed.

Does your grandmother’s neurologist charge Medicare rates or did the doctor’s office charge you their rates and want you to be reimbursed from Medicare what Medicare will pay? That is what it sounds like to me.  Here are a few tips that I tell my clients that can help you, since you are your grandmother’s caregiver.

1)  Before you set the appointment ask the doctor’s office if they accept Medicare and will bill Medicare directly for you.

2)  If they say NO, then you need to decide…Do I want to pay out of pocket and get reimbursed what Medicare pays?  Doctors know they are not paid their asking rates.  Medicare is not the only one who discounts the doctor’s bills.  Group health insurance also discounts the doctor’s bills….OR…

3)  Look for a doctor or specialist that does take Medicare assignment and will bill Medicare.  There are still plenty of fantastic doctors that do accept Medicare.  Even the top specialists in their field still take Medicare. More doctors and specialists are taking Medicare than those that don’t.  Ask your grandmother’s doctor for more than one doctor or specialist that he/she can refer for your grandmother.

Here is how to file a claim if your doctor doesn’t accept Medicare assignment.  You may have to pay the complete bill and submit the claim to Medicare.  See pages 60-61 about “What is assignment?”  of the 2013 Medicare & You handbook which explains how to submit a claim if your doctor, provider or supplier doesn’t accept assignment.  You can call 1/800-MEDICARE (633-4227) and ask for Form CMS-1490S or go to www.medicare.gov/medicareonlineforms.

When you have Medicare on the phone, ask them for help with filing the claim and they will be happy to assist.

Toni King, author of the new Medicare Survival Guide, which is a simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com.  Toni is an advocate/consultant for those “Confused about Medicare”.  Email questions to toni@tonisays.com or call 832/519-TONI (8664). Interested in a workshop for your church/community organization or lunch and learn at work, contact Toni.