Filing a Medicare Claim

How to File a Medicare Claim

Medicare claims should be filed within 1 entire calendar year, after the year in which the services were offered. For instance, if you saw your doctor on March 22, 2009, the Medicare claim for that visitation should be filed by December 31, 2010.

Is Your Supplier or Pharmacy Enrolled in Medicare?

If the answer is no, you will be responsible for the purchases of any supplies or prescription drugs.

Note: Filing a Medicare claim applies only if you are in the Original Medicare Program. If you obtain your Medicare healthcare through a Private Fee-for-Service Plan or a Managed Care Plan, Medicare claims will not be filed. Medicare will pay these private insurance companies a set number each month. Thus, they do not need to file Medicare claims.

Does My Supplier or Provider Accept Medicare Assignment?

You are responsible for your portion of the bill which consists of deductibles and co-insurance to the supplier or provider. The supplier or provider will file a Medicare claim. Medicare will pay its portion of the bill directly to the supplier or provider.

My Supplier or Physician Does Not Accept Medicare Assignment

Note: Only suppliers and physicians could determine to not accept assignment.

If your supplier or physician does not accept the assignment for covered services, your supplier or physician might make you pay all or most of the bill during the period of time you get the supplies or services. However, the supplier or physician must still file a Medicare claim on your behalf. Medicare will then pay its portion of the bill to you directly. Medicare cannot pay you its portion of the bill until the Medicare claim is filed.

You must take these steps if your supplier or doctor does not file the Medicare claim within a timely manner:

  • 1st Step – Get in touch with your supplier or physician: call your supplier or physician directly and ask the them to file your Medicare claim.
  • 2nd Step – Call your local Medicare provider: If the supplier or physician still does not file the Medicare claim after you asked and called, you must visit and contact your local Medicare provider. Additionally ask for the exact time limitation for filing a Medicare claim for the supply or service you obtained.

Important: There is a time limitation for filing a Medicare claim. If a claim is not filed within the specified time limit, Medicare cannot pay its portion. This time limitation might be as short as 15 months or as long as 27 months depending on when you obtained the supply or service.

  • 3rd Step – Time to file a claim: You only need to file a Medicare claim in rare occasions.

File a Medicare claim yourself when:

  • You finished step 1 and step 2 above
  • The supplier or physician still has not filed the Medicare claim
  • It is near the time limitation for filing the Medicare claim. (For instance, if the time limitation is 15 months, you must consider filing a Medicare claim if the supplier or physician has not filed the Medicare claim 12 months after you obtained the supply or service).

To file a claim yourself, you will be required to print out and complete the Form CMS 1490S, Patient’s Request for Medical Payment. This form can be downloaded on the Centers for Medicare & Medicaid Services website.

If you wish for Medicare to give your health information which is personal to someone else, you will be required to inform Medicare in writing. Remember, it is vital to keep track of claims and the time limit you are given in order to file a claim.