US · guidance
CMS Pub. 100-04, ch. 2, § 10.11
Retroactive Entitlement
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.
History
(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)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
9947dcc7ddfbbab458836f8fa3340730035d6bbd680a9110aa636b94331db39d
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