Medicare Billing Policy
EFFECTIVE 4/1/2020 ~ DUE TO COVID, WE ARE “ACCEPTING ASSIGNMENT” ON MEDICARE UNTIL FUTURE NOTICE.
Hilltop Medical Clinics are NON-Participating Provider for Medicare.
Medicare patients are required to pay for their medical care at the time of service. We do not Accept Assignment on Medicare claims. We have a provider number with Medicare for them to process the claim and pay directly to you.
We are payment at the time of service. Hilltop Medical Clinic is required by law to submit your claims to Medicare and/or their TPA, and they will respond directly to you. Please do not submit your own claims to Medicare. Allow 30-45 days before following up with Medicare on an unpaid claim.
Medicare forwards your claims to your supplemental insurance company if you have that insurance on file with Medicare. Hilltop Medical Clinic does not receive an EOMB Explanation of Medicare Benefits from Medicare to do your 2ndary billing. Please contact Medicare with your supplemental insurance information if you have not done so.
I understand that Hilltop Medical Clinicdoes not accept MEDICARE with MEDI-CAL (aka Medi-Medi) patients. You confirm that you do not have MEDI-CAL as a primary OR a supplemental to Medicare.
Medicare will consider reimbursement on the Physician, X-ray and some injection charges. We are notifying you that Medicare will NOT reimburse you for the following services (nor will Hilltop Medical Clinic) and by signing this you understand you will owe for the following services:
Laboratory text performed in our office that get applied toward your deductible.
Handling charges on laboratory test sent to an outside lab.
Various allergy or hormone injections or immunizations (i.e.tetanus). This excludes Flu & Covid Vaccines.
General Physical exams and the corresponding test, including TB tines or PPD tests.
All medical supplies (i.e. Orthopedic, suture tray, dressing, etc.).
Oral prescription drugs purchased from our clinic.
At this time, we are unaware of any other services we provide which are determined by Medicare to be not covered because they are not reasonable and necessary for treatment of illness or injury.
My signature below authorizes Hilltop Medical Clinic to release medical information about me to the HHS for Medicare & Medicaid Services and its agents to determine these benefits payable to related services. I understand my signature requests that payment be made to HMC or me and authorizes release of medical information necessary to process this claim.
I have been informed of Hilltop Medical Clinic’s policy in regards to me, the Medicare patient. The entire bill will be strictly my responsibility to pay today. HOWEVER, EFFECTIVE 4/1/2020 ~ DUE TO COVID, WE ARE “ACCEPTING ASSIGNMENT” ON MEDICARE UNTIL FUTURE NOTICE.
Once you have signed this agreement, you agree to all the terms and conditions contained herein and the agreement will be in full force and effect.