Medicare providers must submit a claim to get reimbursement for services provided to Medicare patients. Medicare providers have two options to submit claims for payment, electronically or via claim form. Providers must use the CMS-1500 claims form to receive reimbursement for all services, other than inpatient services. Electronic submissions must be in the HIPAA 837 format. In the rare event a patient needs to submit a claim, she must use the Patient's Requests for Medical Payment form to receive reimbursement.
Instructions
1. Make a copy of your patient's Medicare ID card. The card will have the beneficiary information such as name, date of birth, ID number and address. This information is required to submit a claim for reimbursement.
2. Complete the CMS-1500 claim form, if you submit paper claims. You must use a printed copy of the form and not a photocopy --- or the claim will face rejection. Additionally, you must fully complete the claim form as claims with missing information cannot be processed and will be returned to you for completion. You can purchase claim forms from the Government Printing Office or private sector printers.
3. Submit the claim form to the appropriate address per the claim form instructions and the carrier you contracted with to provide Medicare services. Call the claims department of the carrier to obtain the claims address, if you do not already have it.
4. Submit Medicare claims electronically using claims software that is HIPAA compliant and meets Medicare requirements. The format of submitted claims is the ASC X12N 837 format. You may need an IT professional to set up the system for you to ensure successful transmittals.
5. Download the "Patient's Requests for Medical Payment" form on the Medicare.gov website, if you are a patient seeking reimbursement. It is rare that your provider would not submit the claim on your behalf. Complete the form, following the instructions and mail to your Medicare carrier. Call Medicare at 800-633-4227 if you do not have the carrier's claims address.
