Medicare changes could affect your wallet

May 4, 2011

Federal legislation affecting how Medicare reimburses physicians requires Medicare providers to reprocess claims dating back more than a year.

This reprocessing, required by federal law, may result in your receiving a refund for Medicare services you received in 2010, or your being billed for additional amounts under your co-pay obligation. In some cases there will be neither a refund nor a balance due.

Because of volume, the reprocessing of Medicare claims by your Medicare provider may continue through February 2012.

To identify reprocessed claims, scan your Medicare Summary Notice for a “5” appearing as the first digit of claim numbers. If there is a balance due, your Medicare provider will notify you directly; and you will receive, directly from your Medicare provider, any refunds due.

For Railroad Medicare beneficiaries, questions should be directed to the Railroad Medicare Beneficiary Contact Center by calling (800) 833-4455 — or the hearing-impaired line, (877) 566-3572 — between 8:30 a.m. to 7 p.m. Eastern Time.

Those not covered by Railroad Medicare should call their Medicare provider.

If you think Medicare should have paid for an item or service, or did not pay enough, you have 120 days from the date you receive your Medicare Summary Notice to file an appeal. Instructions on filing an appeal appear on your Medicare Summary Notice.

For Railroad Medicare recipients, the claim should be filed with:

Railroad Medicare — Palmetto GBA
Attn: Redeterminations
P.O. Box 10066
Augusta, GA 30999

More information on Railroad Medicare may be found at

by clicking on the link, “Additional information is available for Railroad Medicare Beneficiaries.”

Railroad Medicare beneficiaries may also sign up at that website for email updates.