Request for Payment Should Be Obtained in All Cases as

10.8 - Request for Payment Should Be Obtained in All Cases as Protective Application for Hospital Insurance Benefits (Rev. 1, 10-01-03) HO-266, HO-307, SNF-407 To become entitled to HI benefits, an individual must not only be eligible, but must also, prior to death, have filed an application for such benefits (or for monthly social security benefits). Even though the individual meets all eligibility requirements, if the individual does not file the necessary application before death, the individual cannot become entitled, and no payment can be made for hospital services. The provider should obtain a written request for title XVIII payment, filed by or on behalf of a patient, upon admission as described in Chapter 1. Occasionally, a Medicare eligible patient age 65 or over who is admitted to a hospital, has never applied for benefits. A request for payment will protect the eligible patient, the patient’s estate, and the provider against the possibility that timely application will not be filed. If the patient refuses to sign the request, the provider will respect the patient’s wishes. The provider may then require the patient to pay or give assurance of payment in accordance with customary practice for non-beneficiaries. If the patient cannot sign, and is not accompanied by anyone who can sign on the patient’s behalf, an authorized provider official may execute the request for payment on the patient’s behalf. The admission record containing the request should contain the patient’s name and be signed and dated as of the signature date. Where the Social Security Office (SSO), upon the provider’s inquiry for a claim number, finds that an apparently eligible inpatient has not applied for benefits; and that the filing date established by the written request might permit payment (not otherwise possible) for the individual’s inpatient services; the SSO will ask the provider for a photocopy of the admission record containing the signed request. The SSO may ask the provider to file a prescribed application for benefits on behalf of the patient who is incompetent if there is no other qualified applicant. In the case of a deceased patient, who prior to death signed a document that protected the filing date, a provider may apply on behalf of the patient if no other qualified applicant applies within six months of the date of notice of the need for application. However, where a qualified survivor or representative of the estate refuses to file and states in writing that his/her refusal is based upon the fact that filing would be detrimental to the deceased’s estate, hospital insurance entitlement cannot be established and payment cannot be made for services.