Managing Your Medicare

How Can You Submit a Claim to Medicare?

There’s no need to file any Medicare bills or claims. The Original Medicare Plan providers are responsible to accomplish this task. These include skilled nursing facilities, hospitals, physicians, home health agencies, suppliers and pharmacies that are associated with the Medicare program. Medicare Plan providers are required by law to file claims for covered supplies or services you receive from the Medicare Plan provider.

  • It is very important to make sure the supplier or pharmacy is enrolled in the program. If you visit a supplier or pharmacy that has not been enrolled, Medicare won’t pay, and you will have to be responsible for paying the whole bill for supplies and drugs.
  • It is important to file Medicare claims within one complete calendar year following the particular year in which all the services were provided.
  • All the information mentioned above is only valid if you are a part of the Original Medicare Plan.
  • In case you receive your Medicare health plan through a managed healthcare plan like a Private Fee for Service plan or HMO, Medicare claims won’t be filed. Instead, Medicare will pay these private insurance carriers a specific amount each month.

How Can You Hire A Home Health Aide Paid by Medicare?

In case you’re eligible for home health care, and you’re receiving skilled care like nursing or some other form of therapy from a specific home health agency, your Original Medicare Plan will be able to cover home health aide services on an intermittent or part time basis. In order to receive coverage from Medicare, home health aide services need to be a part of the care for an injury or illness.

How Should You Report the Death of a Beneficiary?

In case a Medicare beneficiary has died, a family member, relative or person responsible for related affairs should notify Social Security. You can simply call Social Security Administration toll free number at 1-800-772-1213. In case the monthly Medicare benefits were being paid through direct deposit, you should notify the financial institution or bank about the beneficiary’s death.

  • In case the surviving spouse was living with the Medicare beneficiary at the time of death, he/she will be paid a one time payment of about $250.
  • The person will also receive a one time payment if the surviving spouse was living apart, but received Social Security benefits on the basis of the beneficiary’s earning record.
  • If the person didn’t have any surviving spouse, the one time payment is made to the child eligible for benefits on the basis of the beneficiary’s earning record. This payment is made to the child in the month of death.

How Can You Change Your Address?

If you’re able to receive Social Security benefits, you can easily change the address on the Internet at SSA.GOV by simply answering a set of questions that need to match the information obtained by Social Security in their records. In addition to this, you can also call at 1-800-772-1213.

In case you received a Social Security Statement with an inaccurate or incorrect address, it may be caused when the addresses came from the IRS (Internal Revenue Service). Therefore, you need to correct this error with the Internal Revenue Service, and not Social Security. You can also call the Internal Revenue Service toll free number at 1-800-82-3676. You need to request Form 8822.

What Do You Mean by Assignment in the Original Medicare Plan? Why is it Important?

Assignment is a basic agreement between Medicare and medical professionals including doctors, nurses and other health care providers, and even suppliers of healthcare supplies and equipment like oxygen, wheelchairs, ostomy and braces. Suppliers and doctors who agree to accept this assignment accept the amount approved by Medicare as payment in full for Medicare Part B coverage and supplies. You just need to pay the deductible amounts and coinsurance.

  • There are times, like if you have both Medicaid and Medicare, when your healthcare suppliers and providers need to accept the assignment.
  • If the assignment is not accepted, charges may be higher. Thus, you may have to pay more. In addition to this, you may also have to pay the whole bill.

In the next step, Medicare will send you the bill. There’s a specific limit on the amount your providers and doctors can bill you. There’s a basic term for the highest amount of money doctors and providers not accepting the assignment can charge you for a covered service. This term is called the Limiting Charge.

  • The standard limit is 15% over the basic amount approved by Medicare.
  • The limiting charge applies to some services, and does not apply to equipment or supplies.
  • You need to check with your medical professionals if they accept the assignment.

What are DRGs?

Medicare Severity – Diagnosis Related Groups or MS – DRGs are payment groups specifically designed for Medicare Beneficiaries. MS-DRGs are assigned to patients who have similar clinical characteristics and treatment costs. The MS-DRG is lined to fixed payment amount which is based on an average treatment cost of patients who belong to the group. This information is provided on the final treatment bill, which is then used to decide the amount hospitals should be paid.

What if Your Card is Lost?

In case your Medicare is stolen, damaged or lost, you can easily apply for a new one through the Social Security Administration website. The Medicare card will be mailed at your address within just 30 days. If you have any other questions or you prefer to gather more information, you can all the Social Security toll free number. You can call at 1-800-772-1213. You can also visit the Local Social Security Office.

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