42 USC 1395b-7 - Explanation of medicare benefits

U.S Code last checked for updates: Nov 22, 2024

§ 1395b–7.

Explanation of medicare benefits

(a)

In general

The Secretary shall furnish to each individual for whom payment has been made under this subchapter (or would be made without regard to any deductible) a statement which—

(1)

lists the item or service for which payment has been made and the amount of such payment for each item or service; and

(2)

includes a notice of the individual’s right to request an itemized statement (as provided in subsection (b)).

(b)

Request for itemized statement for medicare items and services

(1)

In general

(2)

30-day period to furnish statement

(A)

In general

(B)

Penalty

(3)

Review of itemized statement

(A)

In general

(B)

Specific allegations

A request for a review of the itemized statement shall identify—

(i)

specific items or services that the individual believes were not provided as claimed, or

(ii)

any other billing irregularity (including duplicate billing).

(4)

Findings of Secretary

(5)

Recovery of amounts

(c)

Format of statements from Secretary

(1)

Electronic option beginning in 2016

(2)

Limitation on revocation option

(A)

In general

(B)

Minimum of one revocation option

(3)

Notification

(Aug. 14, 1935, ch. 531, title XVIII, § 1806, as added Pub. L. 105–33, title IV, § 4311(b)(1), Aug. 5, 1997, 111 Stat. 385; amended Pub. L. 114–10, title V, § 508(a), Apr. 16, 2015, 129 Stat. 169.)

cite as: 42 USC 1395b-7