CMS Clarifies Medicare Claims Process

The Centers for Medicare & Medicaid Services (CMS) recently rescinded Transmittal 1557, released July 18, and replaced it with Transmittal 1588, released Sept. 5, to clarify specific business requirements.

Effective Sept. 18, Medicare contractors are instructed to consider in a timely fashion incomplete claims submitted on CMS-1490S and CMS-1500 forms. Providers and suppliers have up to six months to resubmit corrected claims on the CMS-1490S form.

Providers and suppliers are required by law to submit Medicare claims for covered and non-covered services on behalf of beneficiaries. To submit claims, however, providers must be enrolled in the Medicare program. This does not apply to foreign beneficiary claims submitted for covered services or to DMEMACS for durable medical equipment, prosthetics, orthotics, and supplies.

Any claimant who submits an incomplete claim will receive a notification letter from the Medicare contractor processing the claim with an explanation of the corrections needed in order to process it correctly and in a timely fashion. A letter will also be sent explaining the statutory requirement for providers and suppliers to submit claims for all services rendered to Medicare patients.

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