If you have Medicare, you should know how to file Medicare claims. Most of the time, you won’t need to worry about filing your own Medicare claims. However, knowing how to do it will come in handy when you need to file your own claim.
Since most providers accept Medicare assignment, they file the claim for you. Of course, there are instances where you will need to file your own Medicare claim. Of course, it’s good to know how to file a claim when necessary.
If you need to file a Medicare claim, it’s possible the provider you saw doesn’t accept Medicare assignment. Your claim goes according to Medicare reimbursement rates, even if the bill was more than Medicare’s amount.
For providers that don’t accept Medicare assignment, they can charge patients up to 15% above the Medicare-approved amount.
You may need to file a Medicare claim yourself if a doctor or supplier isn’t filling the claim quickly. Medicare claims must be sent in no later than 12 months after the service.
The Best Time to File a Medicare Claim
It’s highly unlikely that you will need to file your own claim, but that doesn’t mean it can’t happen. If you need to file your own Medicare claim, 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 claim submission doesn’t happen within this time frame.
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.
If your provider or supplier still don’t file the claim, ask for the exact time for filing a Medicare claim. When they say a time near the end of the time limit, you should file the claim with Medicare yourself.
Patient Request for Medical Payment Form (CMS-1490S)
The form you need to fill out is called the Patient Request for Medical Payment Form (CMS-1490S). You’ll need to include an itemized bill from the provider, a detailed letter that explains why you’re filing the Medicare claim, and any supporting documents.
The instructions for each type of Medicare claim are slightly different; you’ll want to follow the steps specific to the reason you’re submitting the claim. Claims for Part B services, Durable Medical Equipment (DME), medical services received on a ship, services in Canada or Mexico, and claims for services in a foreign hospital each have different requirements.
To complete an itemized bill include:
- the date of service
- a description of service, the charge for each service
- name/address of the doctor
- the place of service.
The address to send your claim can be found on the second page of the instructions for the type of claim you’re filing. You can also look at your Medicare Summary Notice.
When you file a Medicare claim more than 12 months after the service it will likely receive a denial. Timely action is necessary. Keeping track of your claims is simple, you can even get your Medicare Summary Notice electronically.
The Medicare Summary Notice (MSN) is a form those with Traditional Medicare get in the mail every 3 months; this form shows all Part A and Part B services or supplies billed to Medicare in the last 3 months. It also shows what Medicare’s payment and the maximum amount you may owe the provider.
If you notice a service falsely put on your statement report Medicare fraud, waste or abuse. Looking over the documents Medicare sends you is very important.
Keeping Track of Your Claims Online
You can easily check the status of Medicare Part A and Part B claims by visiting MyMedicare.gov; all you need to do is log into your account. Most claims are sent in within 24 hours of Medicare processing.
You can even get your MSN online; sign up to receive eMSNs and get monthly emails that link you to your claim 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 form or document all on your own. Although, if you find that you need help with your claim, don’t hesitate to contact someone.
Get Help With Medicare
If you need assistance you can always contact Medicare to file a claim. If possible, you can also ask the doctor to file the claim for you; however, if they won’t, then it’s your responsibility.
With a Medicare Supplement, you can expect to receive coverage where Medicare would leave you responsible. MedicareFAQ has helped thousands of Medicare beneficiaries just like you; we help you find the best plan, enroll, assist you with issues and answer any questions.
Having to submit your own Medicare claim is rare, but it happens. If you frequently see a doctor outside the country that doesn’t accept Medicare assignment, or if a supplier isn’t submitting your claim in a timely fashion, then you must file the Medicare claim yourself.
We have a Client Service Team that can help you every step of the way, at absolutely no additional charge. When you enroll in a Medicare Supplement through us, you have us to help you through any claim issue.
If you wish to enroll online, fill out an online rate form. We have an agent in your state; call the phone number above and get the coverage you need. We also give you the customer service you deserve.