Beneficiary Assignment For Medicare Claims

The provider or institution will file a Medicare claim most of the time. They must file the claim within twelve months of service, but there may be some instances when it doesn’t happen. Your healthcare provider cannot file the claim, or they won’t. Some providers and suppliers do not take assignment for Medicare or are not enrolled with Medicare. Some choose not to certify with Medicare. It would be best if you then did the filing.

I would also ask your Medicare insurance agent for help.

Can I Submit a Claim Directly To Medicare?

Here is how to file Medicare claims, so you don’t get stuck with the bill.

Check your Medicare Summary Notice (MSN) each month. Sometimes providers and suppliers forget to file or are slow. Others do not enroll with Medicare or take Medicare assignment because they want more than what Medicare reimburses.

Rare circumstances may require you to file, like a shipboard medical incident, travel between the lower 48 states through Canada to Alaska, and events across the border in Mexico.

It will be your responsibility to remind the provider to bill Medicare. You will need to file the Medicare claim yourself if the provider refuses.

How To File Your Own Medicare Claim

The Medicare form to complete is Patient’s Request for Medical Payment (CMS-1490S), which you can find on the Medicare and CMS websites.

A successful reimbursement would be helped if you listed the reasons for the medical care. You must identify the cause of the ailment. For example, the injury was work-related, auto accident, dialysis, kidney transplant, etc.  Instruction on how to fill out a Medicare claim form is attached to the form.

How To File A Medicare Claim As A Patient with Other Insurance

You must document any other health insurance, such as an employer’s health plan, including a spouse’s health plan.  Any Medigap policy or Medicaid must be listed. Veterans Administration (VA) is another example during the process of filing a Medicare claim.

HIPPA For Medicare

The form should include supporting documentation, such as the itemized bill. The bill will probably contain the necessary details. Still, if not, you will need to provide the date of service, doctor’s contact information, etc. You may also wish to include the HIPPA form, so there is no communication difficulty between the entities, including your spouse.  All of this is necessary to file a Medicare claim.

Local Social Security Office

You submit the paperwork to the local Social Security office that handles these claims. You cannot do this online. The Medicare website has the contact information for your local office. It is included in the Patients Request for Medicare Payment (CMS-1490S). Beneficiaries are required to file claims within twelve months of the occurrence. Otherwise, it will be rejected.