Form CMS-1490S, also known as the Patient's Request for Medical Payment, is used by Medicare beneficiaries to request reimbursement for medical expenses. This form is typically used in situations where the Medicare beneficiary has already paid for their medical services and is seeking reimbursement.
The following scenarios may require you to complete Form CMS-1490S:
1. Out-of-pocket medical expenses: If you have received medical services that are covered by Medicare but have paid for them out of pocket, you can complete Form CMS-1490S to request reimbursement.
2. Non-participating provider: If you have received medical services from a non-participating Medicare provider who does not bill Medicare directly, you may need to fill out Form CMS-1490S to request reimbursement.
3. Foreign travel emergency: If you are a Medicare beneficiary traveling outside of the United States and experience a medical emergency, Form CMS-1490S may be necessary to request reimbursement for the covered services obtained abroad.
4. Provider billing error: In cases where a provider incorrectly billed Medicare for services that you have already paid, you may need to complete Form CMS-1490S to request reimbursement from Medicare.
When completing Form CMS-1490S, ensure you provide accurate information about the medical services received, the amount paid, and any supporting documentation to substantiate your claim.
It's important to note that Form CMS-1490S is specific to Medicare beneficiaries seeking reimbursement. If you are not a Medicare beneficiary, this form would not be applicable to you.