Medicare billing, enrollment and appeals
Medicare Part B and Part A billing through your Medicare Administrative Contractor, PECOS enrollment, revalidation, and appeals through all five levels.
Working with Medicare
Original Medicare claims are processed by the Medicare Administrative Contractor (MAC) for your jurisdiction, and DME claims by the DME MAC for the patient’s state. Each MAC publishes its own Local Coverage Determinations, which decide documentation and medical necessity rules for many services.
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Plan types we bill:
- Medicare Part B (professional services)
- Medicare Part A (facility claims)
- DMEPOS
- Medicare Advantage plans (billed to the private plan)
Credentialing and enrollment
Providers enroll in Medicare through PECOS using the CMS-855 applications. The MAC issues a PTAN after approval. Enrollment must be revalidated every 5 years, or every 3 years for DMEPOS suppliers.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Claims must be filed within 12 months of the date of service. We submit electronically through your clearinghouse, check eligibility through your MAC’s portal, and track every claim through the 277CA acknowledgment.
Appeals follow five levels, starting with a redetermination, which must be requested within 120 days of the initial determination.
Denials we prevent with Medicare
- Services not meeting the LCD or NCD
- Patient enrolled in Medicare Advantage, not Original Medicare
- Rendering or ordering provider not enrolled
- Frequency limits on screenings and tests
- Missing ABN for services expected to be denied
- Claims filed after 12 months
Questions about Medicare
How long does Medicare enrollment take?
It varies by MAC and application, but many enrollments take several weeks to a few months. Fast responses to development requests keep it moving.
What is an ABN?
An Advance Beneficiary Notice tells the patient in advance that Medicare may not pay for a service, so you can bill the patient if Medicare denies it.
Other payers and related services
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Medicare claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.