(Medicare Claims Processing Manual)

b. Unassigned claim submitted by a public welfare agency on a bill which is paid.  c. Enrollee deceased, bill unpaid and the physician or supplier agrees to accept Medicare approved amount as the full charge.   2. When signature by mark is permitted: The enrollee is unable to sign his name because of illiteracy or physical handicap.   3. When another person may sign on behalf of the enrollee:   a. Enrollee who is resident of a nonprofit retirement home gives power of attorney to the administrator of the home.   b. Enrollee physically or mentally unable to transact business:  The request may be signed by a representative payee, legal representative, relative, friend, representative of an institution providing the enrollee care or support, or of a governmental agency providing him/her assistance.   c. Enrollee physically or mentally unable to transact business and full documentation is supplied that the enrollee has no one else to sign on his behalf:  The physician, supplier, or clinic may sign.  d. Enrollee deceased and bill paid or liability assumed:  Person claiming payment should sign.  If Form CMS-1500 was signed before the enrollee dies, claimant should sign separate request for underpayment.  4. When request retained in file may cover extended future period:  a. Assignment in files of welfare agency covers all services furnished during the period when the enrollee is on medical assistance.   b. Authorization in files of organization approved under 30.2.8.3 covers all services paid for by that organization under that procedure.  c. Assignment in the files of group practice prepayment plan covers services furnished by the plan during the period of the enrollees membership.  d. Assignment in the files of a participating provider (hospital, SNF, home health agency, outpatient physical therapy or speech-language pathology provider or comprehensive rehabili tation facility) or ESRD facility covers physician services for which the provider or facility is authorized to bill, and may cover the physician services furnished in the provider or facility as follows:   Inpatient services - effective for period of confinement.  Outpatient services - effective indefinitely.   e. Assignment in files of individual physician, supplier (except in the case of unassigned claims for rental of durable medical equipment) or qualified reassignee under 30.2 is effective indefinitely.   B.  Physician (Supplier) Signature Requirement   The rules below apply to both assigned and unassigned claims unless otherwise indicated. 1. In a claim for services furnished by an individual physician (or supplier), the physician may:  a. In an unassigned claim, provide an itemized bill on his own letterhead - no physician signature required.  A Form CMS-1500 on which the name or identification code of the physician has been stamped or preprinted in item 31 is the equivalent of the physicians own letterhead.  b. Sign item 31 of Form CMS-1500.  c. Sign one time certification letter for machine -prepared claims submitted on other than paper vehicles.  d. Authorize an employee (e.g., nurse, secretary) to enter the physicians signature in item 31 of the Form CMS -1500.   i.   Manually ii.  By stamp -facsimile or block letters  iii. By computer   e. Authorize a nonemployee agent, e.g., billing service or association, to enter as in d. above, the physicians signature in item 31 of the Form CMS -1500, followed by the agents name, title, and organization (e.g., a billing agent might enter by stamp Dr. Tom Jones by Robert Smith, Secretary, Ajax Billing Service).  Alternatively, the agent may simply enter the physicians signature.   2. In a claim by a clinic, hospital, or other entity authorized to bill and receive payment in its name for the services of the physician, the entity may:   a. In an unassigned claim, provide an itemized bill on its letterhead- no signature necessary. A Form CMS -1500 on which the name or identification code of the billing entity has been stamped or preprinted in item 8 is the equivalent of the reassignees own let terhead.   b. Have authorized official sign in item 25 of the Form CMS -1500 (item 13 of Form CMS -1554, item 6 of Form CMS -1556).   c. Have authorized official sign one -time certification letter for machine -prepared claims submitted on other than paper vehicles.  d. Have authorized employee, e.g., a secretary, enter authorized officials signature in item 25 of the Form CMS -1500 (item 13 of Form CMS -1554, item 6 of Form CMS -1556) as in 1d.  e. Have nonemployee agent enter authorized officials signature in item 25 of the Form CMS -1500 (item 13 of Form CMS -1554, item 6 of Form CMS -1556) as in 1.e.  50.1.7 - Definition of a Claim for Payment  (Rev. 3086, Issued: 10- 03-14, Effective:  ICD -10: Upon Implementation of ICD -10, ASC X12: January 1, 2012, Implementation  ICD- 10: Upon Implementation of ICD -10; ASC X12: November 4, 2014)   For those billing A/B MACs (B) and DME MACs, a claim does not have to be on a form but may be any writing submitted by or on behalf of a claimant, which indicates a desire to claim payment from the Medicare program in connection with medical services of a specified nature furnished to an identified enrollee. It is not necessary that this submission be recorded on a CMS claim form, that the services be itemized or that the information submitted be complete (e.g., a note from the enrollees spouse, or a bill for ancillary services in a nonparticipating hospital, could count as a claim for payment).   The writing must contain sufficient identifying information about the enrollee to permit the obtaining of any missing information through routine methods, e.g., file check, microfilm reference, mail or telephone contact based on an address or telephone num ber in file.  Where the writing is not submitted on a claims form, there must be enough information about the nature of the medical or other health service to enable the contractor with claims processing jurisdiction to determine that the service was appar ently furnished by a physician or supplier.   The definition of a part B claim for purposes of timely filing is any writing submitted by or on behalf of a claimant, which indicates a desire to claim payment from the Medicare program for medical services of a specified nature to an identified enrollee.   For example, a note from the enrollees spouse or a bill for ancillary services in a nonparticipat ing hospital could constitute a claim for payment.   If such a claim is mailed or delivered to SSA, CMS or to any A/B MAC (A or B) within the time limit, the claim is filed timely provided the necessary claims information (e.g., Form CMS -1490S and itemized bill in the case of an enrollee -filed claim) is submitted within the time limit or, if later, within six months after the end of the month in which the claimant is advised to furnish it, e.g., if the notice is provided February 2, the claim must be filed by close of business August 31.  See Statement of Int ent instructions in 70.7.  Note that electronic claims must be in the appropriate HIPAA standard format.  Refer to section 2 of this chapter as well as chapters 24 and 25 for more information.  50.1.8 - Establishing Date of Filing - Postmark Date - Carriers  (Rev. 1, 10- 01-03) A3-3305.2, A3- 3305.3   Whenever the last day for timely filing of a claim falls on a Saturday, Sunday, legal holiday, or other day all or part of which is a non- work -day for Federal employees because of Federal statute or executive order, the claim will be considered timely if it is filed on the next workday.  Where the claim is submitted to the carrier by mail, if it is material and to the advantage of the provider, the claim can be considered filed on the day the envelope was postmarked in the United States.  Thus, where an undated claim is received by the car rier in the mail early in the month after the filing date, the envelope should, if practical, be retained.  If, in such a case, an envelope with a legible postmark is not available, a 7- day tolerance will usually apply.  For example, a claim for services p rovided in May 2000 received by a carrier on or before January 10, 2002, may be presumed by the carrier, in the absence of evidence to the contrary, to have been mailed on or before January 2, 2002, (which is the date the time limit expires because it is the first Federal workday after Saturday, December 31).  This rule will be applicable where the claim was mailed within the contiguous 48 States and the District of Columbia and received by a carrier within such States.  In other cases, the reasonable tolerance may be longer and will depend on the usual mailing time under the particular circumstances.   50.2 - Frequency of Billing for Providers  (Rev. 1231; Issued:  04-27- 07; Effective:  12 -03-07; Implementation:  12 -03-07)  Different types of providers are paid based on different payment policies depending upon the circumstance of the provider.  These payment policies are described in detail in the chapters related to the provider type.  The following billing requirements are to strike a balance between program administration efficiency and maintaining cash flow for providers.  Standard System Maintainer (SSM) shall ensure that providers adhere to these requirements.   50.2.1  Inpatient Billing From Hospitals and SNFs  (Rev. 1946; Issued: 04- 15-10; Effective Date:  10 -01-02; Implementation Date: 07-06-10 for Analysis, Design and Coding and 10-04-10 for Testing and Implementation)   Non PPS Hospitals and SNFs   Inpatient services in TEFRA hospitals (i.e., hospitals excluded from inpatient prospective payment system (PPS), cancer and childrens hospitals) and SNFs are billed:   Upon discharge of the beneficiary;  When the beneficiary benefits are exhausted;   When the beneficiarys need for care changes; or   On a monthly basis.  Hospitals in Maryland that are under the jurisdiction of the Health Services Cost Review Commission are subject to monthly billing cycles.   Providers shall submit a bill to the FI when a beneficiary in one of these hospitals ceases to need a hospital level of care (occurrence code 22).  FIs shall not separate the occurrence code 31 and occurrence span code 76 on two different bills.  Each bill must include all applicable diagnoses and procedures. However, interim bills are not to include charges billed on an earlier claim since the From date on the bill must be the day after the Thru date on the earlier bill.   SNF providers shall follow the billing instructions provided in Chapter 6 (SNF Inpatient Part A Billing), Section 40.8 (Billing in Benefits Exhaust and No-Payment Situations) for proper billing in benefits exhaust and no- payment situations.   PPS Hospitals   Inpatient acute -care PPS hospitals, inpatient rehabilitation facilities (IRFs), long term care hospitals (LTCHs) and inpatient psychiatric facilities (IPFs) may interim bill in at least 60 -day intervals. Subsequent bills must be in the adjustment bill format. Each bill must include all applicable diagnoses and procedures.   All inpatient providers will also submit a bill when the beneficiarys benefits exhaust.  This permits them to bill a secondary insurer when Medicare ceases to make payment.  Initial inpatient acute care PPS hospital, IRF, IPF and a LTCH interim claims mus t have a patient status code of 30 (still patient).  When processing interim PPS hospital bills, providers use the bill designation of 112 (interim bill -  first claim).  Upon receipt of a subsequent bill, the FI must cancel the prior bill and replace it wi th one of the following bill designations:    For subsequent interim bills, bill type 117 with a patient status of 30 (still patient); or   For subsequent discharge bills, bill type 117 with a patient status other than 30. (See Chapter 25 for a list of valid patient discharge status codes)   All inpatient providers must submit bills when any of the following occur, regardless of the date of the prior bill (if any):    Benefits are exhausted;   The beneficiary ceases to need a hospital level of care (all hospitals);   The beneficiary falls below a skilled level of care (SNFs and hospital swing beds); or   The beneficiary is discharged.   Effective December 3, 2007, when a beneficiarys Medicare benefits exhaust in an IPF or an LTCH, the hospital is allowed to submit a no pay bill (TOB 110) with a patient status code 30 in 60 day increments until discharge.  They no longer have to continual ly adjust bills until physical discharge or death.  The last bill shall contain a discharge patient status code.   These instructions for hospitals and SNFs apply to all providers, including those receiving Periodic Interim Payments (PIP).  Providers should continue to submit no- pay bills until discharge.