On March 23, 2010, President Obama signed the Affordable Care Act (ACA), a law that is making many health insurance changes which will roll out for the next four years. Some of the provisions of the new law were effective April 1, 2010, but some were retroactive to January 1, 2010. This includes changes to the 2010 Medicare Physician Fee Schedule (MPFS), which is used to reimburse providers for various services.
Because of the retroactive effective dates involved, Medicare contractors have begun reprocessing a large volume of claims. The reprocessing of Railroad Medicare claims is expected to be completed by late February of 2012.
During this time, you may receive Medicare Summary Notices (MSNs) containing information about claims that you know Railroad Medicare has already processed. You can tell which ones these are because the claim number begins with a '5'. For those claims, your provider may owe you a refund for services you received in 2010 or, in some cases, you may have to pay your provider more co-insurance. In other instances, there will be no changes to what you owe or what the provider owes you.
Please read your MSNs carefully for any changes. If you owe your provider additional funds or if they need to refund money to you, your provider will let you know what to do next.
Should you have any questions about your MSNs, please contact the Railroad Medicare Beneficiary Contact Center at (800) 833-4455 or TTY at (877) 566-3572 for the hearing impaired between 8:30 a.m. to 7 p.m. ET.
If you think that Medicare should have paid for an item or service, or did not pay enough after your claims are reprocessed, you can file an appeal within 120 days from the date you receive your MSN.
To file an appeal, please follow the instructions on your MSN and sign and return the notice to our office at:
Railroad Medicare – Palmetto GBA
P.O. Box 10066
Augusta, GA 30999
For more news and information about Railroad Medicare, please visit our Web site at www.PalmettoGBA.com/RR and follow the link that says 'Additional information is available for Railroad Medicare Beneficiaries'. You can also see news and information related to Railroad Medicare on our Facebook page called 'My RR Medicare' - a new Facebook page created specifically for you.
You can also sign up for e-mail updates at www.PalmettoGBA.com/RR using the 'Beneficiary' listserv category, or you can see us on Twitter at www.twitter.com/PalmettoGBA_RRB.
last updated on 04/29/2011