02The claim
Medicare billing services
Medicare billing services get Original Medicare Part B claims paid by your Medicare Administrative Contractor and keep them paid: PECOS enrollment and revalidation kept current, other coverage checked under the Medicare Secondary Payer rules, an ABN on file when Medicare is expected to deny, the claim sent as an 837P, the 835 posted, and a redetermination filed inside Medicare's 120-day window when a claim is denied.
Enrollment, MSP and appeal deadlines reviewed. No patient data needed.
Medicare Advantage plans run on their own contracts and appeal rules, and we bill those separately.
This is part of getting the claim out clean. Buy it on its own or pair it with our other billing services, stage by stage.
Last reviewed by the Remitwright billing team. Editorial policy
Stage 02 of 04
- Before the visit
- The claim
- After the claim
- Oversight
What we do
What Medicare billing covers
- PECOS enrollment, reassignments and revalidation tracked for every provider, with due dates taken from the CMS revalidation list, which CMS posts seven months ahead
- EDI enrollment with your MAC so claims go electronically, as the ASCA condition of payment requires, and the 835 remit flows back into your system
- Medicare Secondary Payer check at intake for employer coverage, liability, no-fault or workers' compensation, so the right payer is billed first
- ABN (Form CMS-R-131) workflow for services Original Medicare is expected to deny, so liability can move to the patient and the claim is coded to match
- Coverage checks before the claim leaves: the diagnosis supports the service, the frequency is allowed, and the documentation the policy asks for is in the chart
- Claims filed well inside Medicare's one-calendar-year limit, with the exception cases (retroactive entitlement, contractor error) flagged and worked
- Crossovers watched: when the Medicaid or supplemental share does not follow, the secondary claim goes out with the Medicare remit attached
- Redeterminations on CMS-20027 or as a written request, QIC reconsiderations and OMHA hearing requests, each logged with its deadline
- Medicare Advantage claims billed to the plan under its contract, with its Part C appeals tracked apart from Original Medicare's
When it is skipped
What goes wrong when Medicare billing is skipped
The revalidation notice that went to the old suite
CMS asks most providers to revalidate every five years (every three for DMEPOS suppliers) and sends the notice three to four months before the due date, to the contact information on file. A practice that moved never sees it. The due date passes, the MAC holds payment or deactivates billing privileges, and there is no payment for the gap.
Medicare billed first when it was second
A patient still covered by a spouse's employer plan is billed to Medicare as primary because nobody asked at check-in. Medicare pays, the other coverage is identified later, and recovery follows, while the primary claim may already be past that payer's filing window.
The service Medicare was always going to deny
A clinician furnishes a service Medicare is not expected to cover and nobody issues an ABN. The denial arrives as expected, and because the notice that transfers liability was never signed, the practice cannot collect from the patient either.
How we run it
How we run Medicare billing
Enrollment check
PECOS records, reassignments, revalidation due dates and EDI enrollment for every provider and location, fixed before anything else is billed.
Front end
Eligibility with the MSP questions asked, coverage policy checked for the services you bill most, and an ABN issued where Medicare is expected to deny.
Claim
The 837P goes to the MAC through your clearinghouse after a scrub against Medicare's edits, well inside the one-year filing limit.
Remit
The 835 is posted, CARC and RARC codes logged, crossovers checked, and denials handed to the appeals queue with their deadline.
Appeal
Redetermination first, then the QIC, then OMHA when the amount in controversy is met, each level logged with its filed date and expected decision date.
What you receive
What you receive every week
Enrollment and revalidation tracker
Every provider, PECOS status, reassignment, revalidation due date and EDI status, updated as CMS posts new dates.
Weekly Medicare report
Claims sent, paid and denied by CARC, MSP holds, crossovers pending, and open appeals by level with the next deadline on each.
Appeal log
Each Medicare appeal with its level, form, filed date, the payer's stated decision window, and the outcome when it arrives.
Worked example: a revalidation caught with seven weeks to go
A hypothetical internal medicine group with four physicians asks for a billing review. The enrollment check finds one physician on the CMS revalidation list with a due date seven weeks out and no notice in the practice's files: the correspondence address in PECOS is a suite the group left two years earlier. The revalidation goes in through PECOS with the address corrected in the same submission, the MAC's request for a copy of the license is answered, and billing privileges continue without a hold.
Questions
Questions about Medicare billing
Do you bill Medicare Advantage plans or only Original Medicare?
What is the timely filing limit for Medicare?
What happens if we miss Medicare revalidation?
How does a Medicare appeal work when a claim is denied?
How do you know when Medicare is the secondary payer?
Does Medicare require electronic claims?
Can a new physician bill Medicare before enrollment is approved?
Can we outsource Medicare billing and keep commercial claims in-house?
Next step
Enrollment, MSP and appeal deadlines reviewed. No patient data needed.
Three quick questions. No patient data. A billing specialist reads every request and replies in writing.
- Three questions, about two minutes
- No patient data, no software to buy
- A written reply from a biller, not a sales deck
You answer three questions
A billing specialist reads them
A written reply by email
Prefer email? sales@remitwright.com
Request received
Thanks. Your review request is in.
Reference . Quote it if you write to us about this request.
- A billing specialist reads your answers and replies by email.
- If a look at real claims makes sense, we agree read-only access under a BAA first.
- You get a written summary of what is worth working and what it would take. No commitment.
While you wait: see the sample weekly report or read how switching works. You can also download the sample weekly report (PDF).