Medicare claims for deceased persons 011-43010070

When processing a claim for a deceased patient Service Officers must first establish who the claimant is.

The claimant is the person who incurred the cost of the service. The claimant is not always the patient, for example, where a child is the patient the parent/guardian incurs the cost and is therefore the claimant.

Medicare benefits must be paid to the claimant and not the patient.

Standard claiming requirements apply when processing claims where the deceased is not the claimant.

See Patient claim requirements for payment of Medicare benefits for more details.

• Pay Medicare benefits to the claimant, not the patient
• Standard claiming requirements apply when processing claims if the deceased is not the claimant

See Patient claim requirements for payment of Medicare benefits for more details.

Note: where initial notification that a person is deceased is received, Service Officers must follow the instructions in Amend deceased persons Medicare enrolment requirements.

The date of death must not be removed or lifted to process Medicare claims for a deceased person.

When processing a claim for a deceased claimant (or their estate) the Medicare benefit can be paid to the executor or the appointed administrator’s nominated bank account.

Appropriate documentation is required to confirm the identity of the executor or the appointed administrator. This includes a certified true copy of either:

• the Last Will and Testament naming the executor of the estate
• the Letter of Administration naming the appointed administrator, or
• probate from the courts

Service Officers must add a comment on the deceased’s record in CDMS to record notification of documentation by the executor or appointed administrator. The executor, or the appointed administrator, is not required to provide a certified true copy of the Last Will and Testament or the Letter of Administration each time they claim.

The executor or the appointed administrator must submit Medicare patient invoices along with a completed Medicare Claim form (MS014) including nominated bank account details.

If there is no proof of identity for the executor or the appointed administrator, staff must attempt to phone the:

• administrator, or
• executor

If attempts to phone are unsuccessful, return the claim with the Medicare claim needs more information (Z0828) letter. See Resources page for a link.

The executor or the appointed administrator must provide a temporary bank account for the payment of the Medicare benefit.

If a financial institution closes a deceased bank account, electronic funds transfer (EFT) payments automatically reject.

Service Officers must tell the executor or the appointed administrator if a request is made to use a deceased persons bank account details.

If the deceased bank account is not closed, the Medicare benefit may be paid into the bank account. However, the executor or the appointed administrator should check with the financial institution to confirm access to the funds are possible.

Service Officers must check CDMS for bank account details before assessing a claim, if the executor or appointed administrator advises to use the nominated bank account in CDMS.

Stored bank account details for the deceased are not automatically populated into the Medicare mainframe screen from CDMS.

When the deceased has recorded bank details in CDMS, Service Officers must key details into mainframe temporarily (T) when assessing the claim. This allows the Medicare benefit to be paid into the nominated bank account.

Service Officers must check the Safety Net registration for the deceased and make sure they are not listed as the Family contact. See Family registration and confirmation for Medicare Safety Net for more details.

Medicare benefits are payable to the claimant for eligible services provided before the patient’s death.

Standard claim lodgement timeframes apply.

Medicare benefits are payable when a provider:

• attends a patient who dies in their presence
• is called to attend a patient who may or may not be dead
• is called to attend a patient who was alive at the time of the call, but dies before the provider arrives
• attends a patient and determines that their life is extinct, and subsequently issues a death certificate. A Medicare benefit may be claimed under an appropriate attendance item

The Resources page has a link to the Medicare Benefits Schedule (MBS) Online website.

Medicare benefits are not payable when a provider:

• attends a deceased person solely to issue a death certificate
• issues a cremation certificate

Note: Medicare benefits are not payable for the issue of a death certificate. An attendance on a patient to determine their life is extinct can be claimed under an appropriate attendance item. The outcome of the attendance may be that a death certificate is issued. However, Medicare benefits are only payable for the attendance component of the service.