CMS Pub. 100-04, ch. 2, § 30.22

If after application of the above procedures, the provider encounters significant problems

in obtaining information regarding Medicare entitlement or benefits in order to accurately

prepare bills, the provider should contact the A/B MAC (A), (B), or (HHH), or DME

MAC for assistance. However, these requests should be on a non-routine basis. The

MAC will assist providers in obtaining entitlement information. The MAC may

temporarily refuse assistance if a pattern of abuse is discovered. Situations that may

require MAC assistance are:

• When the patient dies following admission. It may be necessary to file timely

with an estate;

• When the patient is not in a physical or mental condition to discuss his/her

entitlement, and no other person with knowledge of the patient’s affairs is

available;

• When the provider has reason to believe the beneficiary may need lifetime reserve

days, and his/her signature must be obtained if the available lifetime reserve days

are not to be used for this admission and other financial arrangements must be

made;

• When it is suspected that the beneficiary may have exhausted his/her Medicare

benefits, and timely confirmation is needed in order to file for possible

supplemental benefits; and

• When the patient has experienced repeated admissions during the same spell of

illness, and determining available benefits for the beneficiary is difficult.