DEC 17, 2012 KAISER HEALTH NEWS in collaboration with 
Dan Driscoll used to be a smoker. During a regular doctor’s visit, his primary-care physician suggested that Driscoll be tested to see if he was at risk for an abdominal aortic aneurysm, a life-threatening condition that can be linked to 
smoking. The doctor said Medicare would cover the procedure. So Driscoll, 68, who lives in Silver Spring, had the test done and was surprised when he got a bill from Medicare for $214.
“I didn’t accept that,” he said, because based on everything he had read from Medicare, he was sure this was a covered service. So Driscoll did something that seniors rarely do: He filed an appeal. Of the 1.1 billion claims submitted to Medicare in 2010 for hospitalizations, nursing home care, doctor’s visits, tests and physical therapy, 117 million were denied. Of those, only 2 percent were appealed.
“People lose, and then they lose heart, or they are too sick, too tired or too old, and they give up,” said Margaret Murphy, associate director of the Center for Medicare Advocacy, which has offices in Washington and Connecticut. “Or their kids are handling the appeal and they are too overwhelmed caring for Mom or Dad.” MORE
How To File A Medicare Appeal Here are some basic steps for challenging Medicare coverage denials…. MORE
Link
Health care providers who appealed to Medicare judges won more often than patients did, according to a report by the inspector general at the U. S. Department of Health and Human Services.
Hospitals, physicians, medical equipment suppliers and other providers also filed 85 percent of the cases decided by the administrative law judges in fiscal year 2010. Some providers get plenty of practice, with 96 “frequent filers” responsible for one-third of the 40,682 appeals submitted to the judges, the IG found. [MORE]
Link
By SUSAN JAFFE May 9, 2012, 3:51 PM 
Belle Likover, a 92-year-old seniors advocate in Shaker Heights, Ohio, led the Ohio Department of Aging’s advisory council last year, and she is not easily deterred by government mumbo jumbo. Still, she
struggled to understand the summary of payments she recently received from Medicare after a five-day hospital stay.
“I don’t understand these codes,” she said. “There are five different doctors listed, and I have no idea who some of them are.”
There’s good news for anyone who, like Mrs. Likover, has ever tried to decipher one of the inscrutable statements, called Medicare summary notices, mailed quarterly to roughly 36 million beneficiaries. Starting next year, officials will begin using a new consumer-friendly format; it’s already available online at www.mymedicare.gov. The mysterious procedure codes are still there, but an easy-to-understand explanation of each service in larger type replaces the descriptions containing baffling abbreviations and medical terms. MORE
Link
$18 For A Baby Aspirin? Hospitals Hike Costs For Everyday Drugs For Some Patients
By Susan Jaffe | April 30, 2012 | KAISER HEALTH NEWS produced in collaboration with 
For the price Diane Zachor, 66, was charged for one pill to control high pressure during her 18 hour stay at St. Luke’s Hospital In Duluth, Min
n., she could have bought a three-week supply. In South Florida, Pearl Beras, 85, of Boca Raton, Fla., said her hospital charged $71 for one blood pressure pill for which her neighborhood pharmacy charges 16 cents. Several other Medicare patients in Missouri were billed $18 for a single baby aspirin, said Ruth Dockins, a senior advocate at the Southeast Missouri Area Agency on Aging.
It’s no mistake: When Medicare patients are in hospitals for observation, they can be charged any amount for routine drugs to treat chronic conditions such as diabetes, high blood pressure or high cholesterol. Medicare doesn’t cover these type of medications and doesn’t require hospitals to tell patients when they are in observation status or that they will be responsible for paying any non-Medicare-covered services.
“I just couldn’t believe some of these prices they charge,” said Zachor (left). “It’s just atrocious.” [More from USA Today or from Kaiser Health News]
Medicare Combats Fraud With Billing Statements That Beneficiaries Can Understand
Susan Jaffe | March 7, 2012 | KAISER HEALTH NEWS produced in collaboration with 
In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass. ….And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud.[Continued here.]…
Obama administration delaying some rules for appealing health insurance denials
By Susan Jaffe | March 30, 2011 | Kaiser Health News produced in collaboration with 
Medicare rules give full hospital benefits only to those withinpatient status
By Susan Jaffe | September 7, 2010 | Kaiser Health News produced in collaboration with 
After Ann Callan, 85, fell and broke four ribs, she spent six days at Holy Cross Hospital in Silver Spring. Doctors and nurses examined her daily and gave her medications and oxygen to help her breathe. But when she was discharged in early January, her family got a surprise: Medicare would not pay for her follow-up nursing home care, because she did not have the prerequisite three days of inpatient care.
“Where was she?” asks her husband, Paul Callan, 85, a retired U.S. Army colonel. “I was with her all the time. I knew she was a patient there.”
Yet some hospitals keep patients under observation for days, and that decision can have severe consequences. Medicare considers observation services outpatient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when receiving inpatient care.And unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge…. more…
What To Do If You’re In Observation Care
By Susan Jaffe | September 7, 2010 | Kaiser Health News produced in collaboration with 
How do I know what my hospital status is? What can I do if the hospital won’t change my observation status to inpatient? If the nursing home or hospital says Medicare won’t cover my nursing home stay, what can I do? Answers to these and other questions here.…