If this is the first time you’ve completed the Beneficiary Selection Form to select a Method, your training nurse (or the billing staff) should be able to tell you what date to put in question #7. Someone may even have filled in a date for you. You put the date signed in question #12.
If you’ve been on one Method and want to change to another. You must do this prior to December 31 (paperwork must be postmarked by this date) for your new Method to start January 1 and you’d put January 1 (year) in #7.
In some limited situations someone can change Methods during the year. In this case, you’d put in #7 the date you’d like the Method change to take place. I suspect in most cases this would be the start of a new month.
I looked online and found info in the Provider Reimbursement Manual Part I, Chapter 27 Section 2740.2D found information about the exceptions that allow you to change Methods at another time besides January 1. If any of these situations happen to you, your clinic will help you complete the appropriate paperwork. [BTW, HCFA has changed its name to the Center for Medicare and Medicaid Services (CMS).]
"D. Exception to Present Selection of Payment Method on Form HCFA-382 (ESRD Beneficiary Selection Form).–Generally, a change from a patient’s current method is not granted, except at the beginning of a new calendar year. HCFA considers the following reasons when granting an exception.
o Failure of a kidney transplant within the past 6 months,
o Patient is confined to a nursing home or hospice,
o Home patient goes infacility for any reason and then elects to go on home dialysis again after at least 6 full months in center,
o Patient changes place of residence and his/her new facility does not recognize their present method of payment, and another facility is not available, or
o Patient is in life-threatening situation.
The intermediary submits the patient’s letter requesting an exception, along with a properly completed Form HCFA-382 to:
Health Care Financing Administration
Bureau of Policy Development
Division of Special Payment Programs
1-A-5, East Low Rise Building
6325 Security Blvd.
Baltimore, MD 21207
HCFA responds directly to the intermediary.
NOTE: If an ESRD dialysis facility and/or an ESRD patient has a question concerning which payment method he/she is presently under, direct these inquiries to the Part A intermediary."