New Law Shifts Medicare Paperwork to Doctors : Health: Beneficiaries will no longer have to fill out complex claim forms. Some say the measure will ease a burden. Others fear it may delay payments.

The nation’s 34 million Medicare beneficiaries are about to have a big burden lifted from their shoulders: They no longer will have to spend hours filling out complex--and often confusing--forms to get reimbursed for their doctor bills.

Starting this month, a new law will require physicians themselves to fill out the claim forms for payments from Medicare.

The federal program will spend $41.9 billion this fiscal year helping to pay medical bills for people over 65 and the disabled of all ages. It also will be limiting physicians’ fees for all Medicare patients. Starting in January, doctors will not be permitted to charge patients more than 25% above the recommended fee schedules of Medicare.

But the new program may prove a mixed blessing for some recipients. It gives physicians up to a year to turn in the forms. As a result, patients now may have to wait months--possibly as long as a year--to get their reimbursement checks from Medicare.

Officials at the Health Care Financing Administration are generally confident that most physicians, already experienced in dealing with Medicare paperwork, will file the forms promptly.

But Kathleen Vallee, regional coordinator for the Los Angeles Medicare Advocacy Project, one of 24 programs run by California’s Health Insurance Advocacy and Counseling Program, is not as sanguine.

With penalties for late filing unusually light, there’s little incentive for physicians to send their forms in very frequently, Vallee said. “A doctor could decide he doesn’t want to hire another bookkeeper and could let the bills pile up in the back room,” she said.

Still, Vallee concedes, the previous system had its flaws as well.

Some older people, puzzled about what Medicare will cover and intimidated by the forms, have neglected to fill out the papers. Beneficiaries lose between $90 million and $130 million a year on Medicare claims they never file, according to a 1989 government survey.

“We’ve had hundreds of frustrated people come in with paper bags filled with bills and Medicare forms, and say: ‘Please help me,’ ” Vallee said.

Spokesmen for beneficiaries’ groups agree. “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 Assn. of Retired Persons.

Medicare essentially has two separate procedures. In one, physicians agree in advance to accept “on assignment” whatever Medicare offers for services, and the federal program pays them directly.

But under an alternative plan, physicians may charge whatever they like. Patients pay the bill and then file a claim form with Medicare, just as they would with a private health insurance firm. Medicare then reimburses them for a portion of the fee.

U.S. officials say that under current procedures, such reimbursement checks usually arrive in fewer than three weeks from the time patients send in their claims. Some 95% of these claims are paid within 24 days, the Health Care Financing Administration says.

Gail Wilensky, the health agency’s chief, says the actual paperwork burden--how difficult it is to obtain reimbursement--varies widely, depending on where patients live and which physician they use.

Because many doctors simply don’t want to accept the Medicare fee as full payment, only about 43% of the physicians who see Medicare patients agree to accept cases “on assignment.” Practices also differ markedly from state to state.

In Massachusetts, state law requires that doctors accept Medicare fees as full payment for all bills. In Oregon, however, beneficiaries filed claims covering 33% of the bills, according to a Health Care Financing Administration survey of the insurance firms that are processing Medicare claims for the government.

Medicare recipients in Southern California filed claims for nearly 9% of all their medical bills, compared with just 4.2% for Central and Northern California--indicating that doctors in Southern California are much less likely to accept Medicare fees as full payment.

Some specialists, such as anesthesiologists, also are reluctant to accept Medicare fees as full payment.

In any given year, 25 million of the 34 million Medicare enrollees will use physicians’ services, federal officials say, and users will have no way of knowing in advance which physicians will accept the government’s fee without demanding additional payments.

To be sure, Medicare forms can be intimidating--particularly for an elderly or frail patient who may have just been released from a hospital stay that involved, say, five or six physicians.

Vallee’s Medicare advocacy organization and other counseling groups have volunteers working at senior centers to help untangle the complexities of the system.

Some doctors have been doing the filing on behalf of their patients free of charge, and others charge $5. But many other patients must struggle with the forms on their own.

For these people, the new billing system transferring the burden to the doctors is a great relief, the Health Care Financing Administration’s Wilensky insists. “It’s the first in a whole series of activities coming on line to ease the burden for the elderly,” she said.

Most doctors are already used to dealing with Medicare, billing the government once or twice a week for their reimbursement, said Barbara Gagel, the Health Care Financing Administration’s director of program operations. Now the doctors will submit the patients’ reimbursement forms with their own.

Gagel says the Health Care Financing Administration will still pay the bills even if the reimbursement is mistakenly submitted by the patients rather than doctors.

The government also will monitor the bills. If a particular doctor’s patients are regularly submitting bills after September, federal officials will contact the physician to remind him of his responsibility to handle the bills.

But Vallee says patients should become strong advocates for themselves. If they haven’t received reimbursement within a month, they should contact the physician--or the insurance company that is acting as the Medicare carrier--and ask what happened to the bill.