Friday, July 9, 2010

Medicare Reporting Requirements

Medicare has implemented reporting requirements to help control costs and to keep proper records of patient care. Reporting requirements are important to adhere to where Medicare is concerned because failure to do so could result in the termination of benefits or the non-payment for a service that had already been provided. As a result the patient would become responsible for the expense. Some areas are a little confusing as to whether reporting is necessary. If in doubt it is better to report extra information to Medicare than not enough.


Secondary Payer








Medicare may be set up as a secondary payer on an account. If this is the case it is required that Medicare is notified of all procedures that may be billed to Medicare for secondary coverage. Medicare also requires pre-qualification for some procedures before they are performed or else secondary payment may not be provided by Medicare.








Health Insurance Claim Number


Many individuals feel leery about providing their social security number to anyone, regardless if it is being requested for official business or not. However, when filing information for Medicare benefits this information is required for Responsible Reporting Entity (RR) to provide. If an individual does not want to provide the information directly to an RRE representative, it is possible for the patient to submit the information on an official model collection form that is mailed to the RRE office. Failure to provide the information may cause frustration on the part of both the RRE and the individual as the information must be included; claims cannot be completed until the file has either a SSN or a Health Insurance Claim Number attached to it.


Health Reimbursement Account


Health Reimbursement Accounts (HRA) that are not joined with a group health plan must be reported to Medicare. HRA's that are not combined with a group health plan were required to complete registration with Medicare by June 30, 2010 to be in compliance with the mandatory reporting regulations. However, if the benefits of an HRA do not overlap with the coverage provided by Medicare then the HRA doesn't have to be registered. If it is uncertain whether or not the benefits overlap or not it is better to register the HRA than to be required to pay penalties.

Tags: benefits overlap, Claim Number, group health, group health plan, Health Insurance, Health Insurance Claim