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Posts Tagged ‘How to File a Claim for Medicare’

The U.S. Department of Justice (DOJ) has reached an agreement with the city of Humboldt, KS that will improve access to all aspects of civic life for individuals with disabilities. Several important steps will be taken to improve access for individuals with disabilities. Improvements include making physical changes so that parking, routes into the buildings, entrances, service areas and counters, restrooms and other areas are accessible. The agreement was reached under Project Civic Access (PCA), the department’s initiative to make sure that cities, towns and counties comply with the Americans with Disabilities Act.

Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five levels in the Medicare Part A and Part B appeals process. The levels are:

First Level of Appeal:    Redetermination by a Medicare carrier, fiscal intermediary (FI), or Medicare Administrative Contractor (MAC).

Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC)

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CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2010

Most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law.  This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50.  The Administration continues to urge Congressional action that would protect all beneficiaries from higher Part B premiums and eliminate the inequity of a high premium for the remaining 27 percent of beneficiaries.

By law, the Centers for Medicare & Medicaid Services (CMS) is required to announce the Part A deductibles and Part B premium amount – a notice that is published annually in the Federal Register.

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CMS uses five different provider and supplier enrollment applications. In general, Part A providers are required to use the CMS-855A to enroll or update their enrollment information; Part B suppliers (except suppliers of Durable Medical Equipment, and Prosthetics, Orthotics, and Supplies (DMEPOS)) are required to use the CMS-855B to enroll or update their enrollment information; physicians and non-physician practitioners are required to use the CMS-855I to enroll or change their enrollment information; and DMEPOS suppliers are required to use the CMS-855S to enroll or update their enrollment information.  In addition to these four enrollment applications, individual practitioners who would like to reassign their benefits to an eligible provider or supplier or terminate an existing reassignment agreement would use the CMS-855R.

To ensure timely processing of your application, make certain to completely fill out the application and provide all required supporting documentation at the time of filing. Section 17 of the Medicare enrollment application lists the supporting documentation that you will need to submit with your enrollment application. Once you have completed the application, you should mail it to the Medicare contractor servicing your state.  A contractor can generally process your application within 60 days if you submit a complete application with all required supporting documentation.  It will take longer to be enrolled if you are a provider or supplier that requires a State survey or accreditation.  If you have any questions about the enrollment process, please contact your Medicare contractor.

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How to File a Claim for Medicare

If you are in the Original Medicare Plan, providers (e.g., hospitals, skilled nursing facilities, home health agencies, and physicians) and suppliers are required by law to file Medicare claims for covered services and supplies that you receive. You should not need to file any Medicare claims.

Medicare claims must be filed within one full calendar year following the year in which the services were provided. For example, if you see your physician on March 30, 2009, the Medicare claim for that visit must be filed by December 31, 2010. Read the rest of this entry »

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