Lesson 1 Summary
- Punishment for defrauding the federal government may involve prison, fines, or both.
- Providers should submit claims for patients in Original FFS Medicare to the appropriate MAC.
- Claims for patients in a Medicare Advantage plan should go to the patient’s MA plan.
- Medicare Part A pays for hospital expenses, SNF and HHA services, blood clotting factors, and short-term inpatient care under hospices.
- Providers may bill patients for their unmet Part A deductible, the first 3 pints of blood, Part A coinsurance, and services Medicare doesn’t cover.
- You must submit claims electronically unless you qualify for a waiver.
- You must file claims to the correct MAC no later than 1 CY after the date of service.
- If you don’t file a claim on time, you can’t charge the patient for the services. You can only charge the patient for deductible or coinsurance amounts that would have been due if Medicare payment had been made.