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1992.02.03 :  Medicare Form Revisions

Contact:  Bob Hardy (202) 245-6145
February 3, 1992

        Revisions to a Medicare form will provide beneficiaries
with clearer explanations of payment decisions made by
contractors who process Medicare claims, HHS Secretary Louis W.
Sullivan, M.D., announced today.
        "The major revision of this form was undertaken because
of our strong commitment to better communication with the people
served by the Medicare program," Secretary Sullivan said.
        Medicare carriers started Jan. 1 to phase in the use of
the new form.  Carriers are insurance companies under contract
with Medicare to process claims for medical services.
        After a provider has been paid for services to a
beneficiary, the explanation of Medicare benefits form is sent to
advise the beneficiary of the services for which Medicare made
payment, the amount paid and the provider who received payment.
         The form furnishes the beneficiary with information
needed to file an appeal if a claim has been denied in whole or
in part by the carrier.  For beneficiaries who have Medigap
insurance policies that cover Medicare deductibles and
coinsurance costs, the EOMB may be submitted to the private
insurers to obtain payment for those charges.

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        Gail R. Wilensky, Ph.D., who directs the Medicare program
as administrator of the Health Care Financing Administration,
said that "government agencies are frequently criticized for
publishing material that confuses the readers instead of
informing them.  In HCFA, we are insisting that information be
presented in understandable terms.
        "We are pleased that senior citizens organizations and
advocacy groups worked with us to produce a greatly improved
Medicare form for reporting payment decisions on claims," she
said.
        The format, content, and print type and size of the new
EOMB were tested nationally in focus groups of beneficiaries who
found the form easy to read and comprehend.
        One purpose for the new and clearer EOMB is to help
beneficiaries more easily identify instances in which Medicare
has paid for services which they did not receive.
        "Inquiries and complaints by Medicare beneficiaries are
the basis for many of the investigations of Medicare fraud and
abuse," according to Dr. Wilensky.
        Medicare carriers receive about 43,000 phone calls a year
from beneficiaries reporting potential cases of fraud and abuse. 
They handle approximately 600 million claims annually,
investigate questionable charges and refer evidence of fraud to
the HHS Office of Inspector General.

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