Q: Is it difficult to file a Medicare claim?
A: No, it not a difficult task (and it’s also not one that you should have to do often, since the vast majority of doctors are participating providers with Medicare and will file the claims on your behalf). But the timeliness of the filing is important, and you can only file a claim if you are enrolled in Original Medicare (Part A and Part B).
Medicare claims must be filed within 12 months of the date of service – again, this isn’t usually an issue, since the providers generally file claims soon after the treatment is provided. But if you have a medical visit on January 25, 2015, the claim must be filed with Medicare by January 25, 2016, at the latest.
Let’s say a doctor you visited does not file his or her Medicare claim in a timely manner. You must take these steps:
- Contact the physician or service provider and ask that person to please file a claim so you may receive your coverage.
- If the provider still does not file a claim for you, call 1-800-633-4227 (1-800-MEDICARE) and report the problem.
- If you have completed the two steps mentioned previously, and the provider still hasn’t cooperated, then you file a claim (download from “Medicare Online Forms” section of www.medicare.org).
Every three months, you should receive a Medicare Summary Notice (MSN) that details your Medicare claims from the previous three months. Check your MSNs to make sure that claims are being filed in a timely manner, and contact your doctor’s office if you’re concerned that they aren’t.
Alternatively, you may file a Medicare Claim yourself for services that another provider offered. The form is called “Form CMS 1490S” and is available at www.cms.hhs.gov.