Medical Billing and Filing a Claim
It is important for you to know that there is a time limit for filing a Medicare claim. Medicare claims must be filed within one full calendar year in which services were provided. IF a claim is not filed within this time limit, Medicare cannot pay you its share. It is important that you ask the Medicare carrier or the billing department what the time limit is for filing your medical claim.
If you are in the Original Medicare Plan, providers of your medical needs such as hospitals and physicians, and suppliers are required by law to file Medicare claims covered services and supplies on your medical that you receive. You should not have to file any Medicare claims. The health care providers billing department will do this for you.
Make sure your pharmacy or supplier that you opt to use is enrolled in Medicare. If they are not, you will be responsible for the entire bill for any drugs or supplies purchased. This is very important information to require before you make your purchase.
This information only applies if you are in the Original Medicare Plan. If you receive your medical health care through Private Fee-for-Service Plan or Managed Care Plan. Medical billing for Medicare claims are not required to be filed. Medicare pays these private insurance companies a set monthly amount.
You pay your share of the bill, such as deductibles, to your medical provider or supplier. In return, your provider or supplier will file a Medicare claim. Medicare will pay its share of the claim directly to the medical provider or supplier.
If your medical physician or supplier does not accept assignment for covered services, you may be required to pay most or all of the bill at the time you receive services. Your physician or supplier is still required to file a Medicare claim in your behalf. Medicare will then pay the bill directly to you, however, Medicare can not pay you its share if a Medicare claim is not filed. To ensure this doesn’t happen, there are a few steps you can take.
- Call your physician or medical supplier directly and ask them to make certain to file a claim.
- If your physician or medical supplier does not file a claim after you have called and asked, call your local Medicare Carrier. Your local Medicare Carrier will contact the physician or medical supplier in your behalf.
- It is very rare that you should have to file a Medicare claim, if you should have to do so, simply call your local Medicare Carrier and ask for the forms in which you will need to fill out. They will be happy to answer any of your questions about how to complete the claim form.
