Most of the time, you won’t need to worry about filing your own Medicare claims. Since most providers accept assignment, they file the claim for you. But, knowing how to do it will come in handy in case you need to file your own claim. If you need to file a claim, it’s possible the provider you saw doesn’t accept the assignment. Your claim goes according to Medicare reimbursement rates, even if the bill was more than Medicare’s amount. Claims must be sent in no later than 12 months after the service.
How to File a Medicare Claim Yourself
If you need to file your own Medicare claim, you’ll need to fill out a Patient Request for Medical Payment Form, the 1490S. Make sure it’s filed no later than 1 full calendar year after the date of service. Medicare can’t pay its share if the submission doesn’t happen within 12 months. You can log in to MyMedicare.gov and view your claims to ensure they are being filed in a timely fashion. If your claims aren’t being taken care of, contact the doctor and ask them to file the claim.
Who Submits Medicare Claims?
For the most part, your doctor will submit claims. But, in some instances, like foreign travel or doctors that don’t accept assignment, you’ll file the claim. If you receive an Advance Beneficiary Notice of Noncoverage and decide to proceed, it’s best to request your doctor submit the claim to Medicare before billing you.
How Are Medicare Claims Processed?
Your doctor will submit the claims. Then, Medicare will take about 30 days to process the claim. When it comes to Part A services, Medicare will pay the hospital directly. But, with Part B claims payment depends on whether or not the doctor accepts Medicare assignment. For doctors that accept assignment, claim payment will go directly to that doctor or the facility. But, for doctors that don’t accept assignment, the claim comes to you. While Medicare in some states doesn’t allow excess charges, many states allow doctors to charge 15% more than the Medicare-approved amount. If you don’t have a Medigap plan, you’ll be responsible for any applicable deductible in addition to the 20% coinsurance as well as the 15% excess charges.
How to Bill Medicare Secondary Claims
Medicare isn’t always primary. In this instance where Medicare is secondary, you’ll bill the primary insurance company before Medicare. Then, you can submit an Explanation of Benefits from the primary payor with the claim. The primary payer must process the claim first, and if they don’t, your doctor may bill Medicare.
Where to Send Medicare Claims
False Claims Act
The False Claims Act is also known as the “Lincoln Law.” It’s a federal law that establishes liability for knowingly filing a fraudulent claim for payment from the United States government, this includes Medicare and Medicaid.
What Does Medicare Adjustment Mean?
Adjustment claims will be submitted when changing the information on a previous claim is necessary. The change made must impact the processing of the original bill for the change to take place.
How Do I Keep Track of Claims Online?
You can easily check the status of Medicare claims by visiting MyMedicare.gov; all you need to do is log into your account. Most claims are sent in within 24 hours of processing. You can even get your Medicare Summary Notice online; sign up to receive an e-Medicare Summary Notice and get monthly emails that link you to your details. With this, you get the most up to date information and no waiting 3 months for a letter.
Medicare is trying to make it simple for beneficiaries; there are many tools that can help you complete any Medicare form or document on your own. Although, if you find that you need help with your claim, don’t hesitate to contact someone.
How to Get Help With Medicare Claims
If you need assistance you can always contact Medicare. If possible, you can also ask the doctor to file the claim for you. However, if they won’t, it's your responsibility.
MedicareFAQ has helped thousands of Medicare beneficiaries just like you find the best plan. We can help you enroll, assist you with issues, answer any questions, help you file a claim, or appeal a denial of a claim.
Having to submit your own claim is rare, but it happens. If you frequently see a doctor outside the country that doesn’t accept assignment, or if a supplier isn’t submitting your claim in a timely fashion, then you must file the claim yourself.
We have a Client Care Team that can help you every step of the way. When you enroll in supplemental Medicare through us, you have us to help you through any claim issue.
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