To view a pdf of this advisory, please click here.
On May 7, 2010 the Centers for Medicare and Medicaid Services (“CMS”) issued a policy change for the timely filing limits for providers and suppliers who submit claims to Medicare for payment, following changes mandated by the new healthcare law -- H.R. 3570, the Patient Protection and Affordable Care Act (the “Act”), signed into law on March 23, 2010.
Section 6404 of the Act amended the timely filing requirements for submission of Medicare claims to one calendar year after the date of service. Previously, under some circumstances, service providers had up to 26 months to submit a claim to Medicare. When considering the time constraints of settlements involving Medicare beneficiaries, especially the need to finalize Medicare reimbursement claims, this “open” period caused gaps that led to delays in securing final demands.
This policy change should help minimize the number of times that conditional payment amounts are significantly different from the final demands, as providers will have to be more timely in their submissions.
However, although this policy will allow for a more accurate conditional payments and final demands process, it’s important to note that this policy does not affect any of the current MSPRC timeframes, processes or procedures for protecting Medicare’s interest. Accurate auditing and analysis of the conditional payment listing is critical to assure that your obligations for reimbursement to Medicare are met and at the same time, achieve the best results for your clients.
Finally, should a provider fail to submit a claim in a timely manner resulting in the claim being denied for “untimely filing,” the provider may NOT bill the beneficiary for the service.
For more information about how your firm’s Medicare compliance program can be updated to take into account these timing issues, please contact us.
i. These amendments apply to all services on or after January 1, 2010. This section of the Act further mandates that all claims for dates of service prior to January 1, 2010 must be submitted no later than December 31, 2010. The Medicare Policy provides:
1. Claims with dates of service prior to October 1, 2009 are subject to the timely filing limits pre-Act.
2. Claims for dates of service October 1, 2009 -December 31, 2009 must be submitted on or before December 31, 2010. Claims received after December 31, 2010 will be denied for untimely filing.
3. Claims with dates of service on or after January 1, 2010 that are submitted more than one calendar year after the date of service will be denied for untimely filing. For instance, claims for date of service on May 1, 2010 must be received on or before May 1, 2011.
ii. According to 42 CFR § 424.44, service providers were required to submit claims for services provided on or before December 31 of the following year for dates of service occurring January – September. For services provided October – December, the provider was required to submit claims on or before December 31 of the second year.
Leave a Comment