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How to File a Medicare Claim


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

You can submit your claims for Medicare online through your “MyMedicare.gov” account. Or, you can send your paper claim to the address on the Medicare Summary Notice.

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.

FAQs

What is a Medicare Claim Number?
A claim number helps Medicare track your claim. This number is most likely your social security number with a letter after it.
How Do I Get a Medicare Claim Number?
The fastest way is to create and log into your MyMedicare.gov account. There you’ll find your claim status and associated claim number. Or you can call Medicare directly.
How Long Does Medicare Have to Pay a Claim?
Medicare can take up to 30 days to process your claim.
How do I file a foreign travel claim?
Foreign emergency services won’t submit claims to Medicare. Instead, you’ll fill out a patient request for a medical payment form.
What to do if Your Medicare Claim is Denied?
If your Medicare claim is denied, you’ll want to file an appeal.
Where can I find the Medicare claims processing manual?
The Medicare claims processing manual is available online. The manual goes over all kinds of payment situations, necessary criteria, and more.

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.

We have an agent working in your state. Call the phone number above and get the coverage you need. If you wish to see your supplemental Medicare options now, fill out our online rate form.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “How to File a Medicare Claim

  1. Hi Lindsay, my name is Robert Shannon. On April 8, 2019 I had hip replacement surgery as a result of a fall, and a diagnosis of AVN(Avascular Necrosis). My orthopedic surgeon sent me to Preferred Imaging in Plano, Texas for an MRI. I just found out that they never filed for Medicare to cover this procedure. The reason I never found this out was because I didn’t receive a bill and they were covered under an LOP from my attorney who represented me in a law suit due to my fall. This money is owed to them, but do I have any recourse due to their failure to file, and/or can the time period that the amount was in litigation be factored in to allow for a late filing?

    I am at a loss as to what to do. Will you please help me with this conundrum I have found myself in?

    Thank you, Robert.

    1. Hi Robert! This is a tough one. The claim must be filed no later than 12 months after services were provided. It seems you have passed that 1-year deadline. An LOP is usually used when the plaintiff has no health insurance. If you had Medicare, then your doctor should’ve just billed Medicare for the surgery instead of accepting a LOP from your attorney. It’s my understanding that your doctor should’ve been paid for his services with your settlement funds. It sounds like you may have lost the lawsuit, and now the doctor is suing your attorney for the cost of the surgery. Unfortunately, this may be something you have to settle between you and your lawyer since he/she is the one who gave your doctor the LOP that stopped them from billing Medicare for your surgery in time. You may be able to get additional information from Medicare. I would call Medicare to see if there is an extension to file the claim due to the litigation. Sorry I couldn’t help more!

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