Retroactive Entitlement

10.11 - Retroactive Entitlement (Rev. 3441, Issued: 01-15-16, Effective; 12-31-13; ASC X12: 01-01-12, MAC Implementation: 02-16-16; ASC X12: 02-16-16) When an application for social security benefits is filed by a person 65 years of age or older, the person may inform the SSO that he/she received hospital services in the retroactive period of up to six months for which he/she may be entitled to benefits. In these cases, the provider may bill for covered retroactive services but must verify the patient’s eligibility through the A/B MAC (A), (B), or (HHH), or DME MAC before billing. If the patient paid, the provider must refund the appropriate amount to the patient.