Continental Health Alliance Blog

Filing Medicare Claims

Filing Medicare Claims

Let’s be honest. Very few people truly understand Medicare in all of its various complexities. Very commonly patients are not well informed as to when to file a claim or how to do so. The purpose of this article is to clarify the topic and remove as much of the confusing jargon as possible.

Do I need to file?

Rarely will a patient on the Original Medicare plan ever need to file a claim. Doctors and suppliers are actually required by law to file claims for services and supplies that you receive. If you are filing a claim your doctor or supplier has dropped the ball and had not done a very important part of their job description. On the other hand, those with the Medicare Advantage Plan (also known as Part C) do not file claims at all because Medicare pays private insurance companies a set amount each month.

When to file a claim?

A claim cannot be made any later than a full year after service has been provided. Unfortunately, after a year Medicare will be unable to pay any of its share. If your claims are not being filed in a timely manner, contact your doctor or supplier and ask them to file a claim. In the event that they don’t, call 1-800-MEDICARE and find out how much longer you have before the one year mark. If you are approaching one year, file the claim yourself.

How to file:

CMS.org features a “Patient Requests for Medical Payment Form” on their site that includes guidelines for submission. After completing the form you must attach an itemized bill for a doctor or supplier, and Medicare will pay the individual directly. The bill does not have to be paid prior to completing the form or for Medicare to process the claim. If you are unaware of where to address your form you can call 1-800-MEDICARE for further instruction.

The above information outlines the proper procedure for filing a claim with Medicare. Although patients should rarely, if ever, need to file for themselves, there are a few guidelines that can make the process easy to navigate and complete. If you would like to learn more visit Medicare.gov for more information.

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