This video will provide you with a high-level Medicare claims overview. It includes basic information about the Medicare fee for service billing process. If you're looking for more detailed information beyond this introductory level video, please visit the CMS website at WWF gov and search for Medicare Learning Network (MLN). - What is a Medicare claim? A Medicare claim is a payment request for the benefits or services you provide to the beneficiary. - Before filing a Medicare claim, know these four steps: 1. Obtain payment from Medicare by applying for both a national provider identifier (NPI) and enrollment in the Medicare program. 2. Do not file a Medicare claim for services furnished outside the United States or non-covered services, unless the beneficiary requests submission to Medicare, or if you have opted out of the Medicare program or been excluded/debarred from it. 3. Determine Medicare secondary payer status. If another plan, insurer, or program is the primary payer, file with the primary payer first, and then identify such payers on the claim you submit to Medicare. 4. Collect the beneficiary's unmet deductibles, coinsurance, and co-payments. Now you're ready to submit the claim. - File your Medicare claims with CMS claims contractors, also known as the Medicare administrative contractors or MACs. MACs process Medicare Part A, Part B, and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims. Medicare claims have timely filing requirements, so make sure to follow up with your MAC no later than one calendar year from the claims date of service. - How do you submit the claims to your MAC? CMS requires the submission of electronic claims via electronic data interchange (EDI), except in limited situations. In limited situations, you may submit paper claims to Medicare. Contact your MAC for more information about electronic or paper claims. - After you've...
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Medicare.gov cms-40b Form: What You Should Know
If you need help, call the toll-free telephone numbers for your state's Social Security office: TTY: Voice:. What's the deadline to apply for enrollment in Part B? All forms are due at least 45 days before you can enroll in Part B. Filing a claim for coverage before enrollment begins is not enough to keep you out of Medicare. You only have to enroll in Part B when you receive Form SS-6, Benefits Eligibility Certificate (BEC). If you lose your BEC or never receive it, you may still be eligible for Social Security Disability benefits. The deadline to file a claim for Coverage for the first month in which you want to enroll in Part B is September 30, if you are age 55 or older. If you don't file a claim by the deadline, you will probably get a notice that you're not eligible and that you have until January 1, 2017, to enroll. How do I add an employer to my Medicare? The main point of using Form CMS-40B is to get you enrolled in Medicare, so you should contact an SSA agent at the point of application if you want any information about that process. If you need help, contact your state social security office at or. If you need Medicare, the National Center for Medicare and Medicaid Services What if I'm not sure if I'm eligible? It's possible you could be considered disabled for all or some of the months during the year you applied and for the month you are enrolling in Part B. If you are considered disabled because of your health condition, you may qualify for Special Supplemental Security Income (SSI) payments or Supplemental Security Income — Unearned (SSI-Unearned) payments. Learn more at Health Care Coverage for the Disabled and Older Americans. If you want to keep your benefits, it's necessary to keep your Medicare enrollment current. If you're still under 65 at age 65 on December 31, you must enroll in Medicare Part B in all the months from December 31, 2015, through December 21, 2023 (except as noted below). In addition, you'll need to enroll in a new Medicare Advantage plan in 2016. You might also get a notice about having to pay a fine.
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