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Physicians Soon Will Have to File Medicare Reimbursement Claims

August 28, 1990

WASHINGTON (AP) _ Beginning next week, all physicians will be responsible for filing reimbursement claims for their Medicare patients.

The Sept. 1 change is welcomed by advocates for the elderly as a relief from what many say is confusing and time-consuming paperwork that discourages some patients from filing the forms and receiving reimbursement.

But it is dreaded by many physicians who envision a bureaucratic nightmare.

″This is one of those instances where someone is trying to fix something that wasn’t broken in the first place,″ said Dr. Joseph F. Boyle, executive vice president of the American Society of Internal Medicine.

The bulk of the estimated 450 million Medicare claims expected to be filed this fiscal year will have been submitted by physicians or medical suppliers, said Barbara Gagel, the government official responsible for implementing the new provision.

About 10 percent of the bills are submitted by patients themselves. Medicare officials do not know how many physicians this represents.

″Now Medicare beneficiaries will receive the benefits to which they are entitled without having to deal with the burdensome paperwork,″ said Horace Deets, executive director of the American Association of Retired Persons.

Nearly one in 10 Medicare beneficiaries polled in 1988 by the Physician Payment Review Commission said they did not file a Medicare claim for at least one bill that they paid that year. Most often they said the forms were too complicated or time-consuming.

These unfiled claims amounted to between $90 million and $130 million, the commission estimated.

The change in filing regulations was approved by Congress last year, but one member, Rep. Joe Kolter, D-Pa., is already trying to repeal it with legislation introduced last May.

″We think it’s an unnecessary burden on physicians,″ said Bob Powers, Kolter’s senior legislative assistant.

″We’ve gotten a lot of mail from Medicare recipients who are insulted″ because they feel the provision implies that they can’t fill out the forms themselves, Powers said. ″They want to do it themselves,″ usually because they can do it faster than a physician’s office staff can.

Physicians will have up to a year to file claims, less than half the time now allowed. Failure to file would mean $1,000 fine for each violation.

Although most don’t foresee extraordinary filing delays, Boyle said patients who now submit their forms promptly could be disappointed that their physician takes longer.

Physicians will not be allowed to charge Medicare patients for preparing and filing claim forms. But, as is the case now, doctors can require payment in full from the patient at the time of service.

Dr. Norton J. Greenberger, president of the American College of Physicians, the largest professional organization of internists, said the change has a ″desirable goal″ of easing the paperwork burden on patients. It also will encourage electronic billing and could speed payments, he said.

But some physicians see the change as ″further intrusion by the government into their office practices,″ he said.

Initially at least, the government will accept a bill filed by a Medicare patient. When the beneficiary is paid, Medicare officials will inform him or her that the physician is supposed to file claims, said Gagel, an official of the Department of Health and Human Services.

The impact on physicians will vary from state to state. An informal sampling by insurance carriers that process Medicare claims suggests it will have the most impact in Oregon, where the proportion of doctors who don’t file patient claims was estimated at about 30 percent, she said.

Indiana and Colorado were next with 13 percent and 12 percent, respectively. At the other end was Massachusetts, where nearly all physicians already file Medicare forms for their patients, Gagel said.

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