BILLING NEWS

Timely claim filing guidelines for all Medicare providers

Medicare regulations establish a time limit for submitting claims to the contractor within the established timeliness parameters. In general, such claims must be filed on, or before, December 31 of the calendar year following the year in which the services were furnished. Services furnished in the last quarter of the year are considered furnished in the following year; i.e., the time limit is the second year after the year in which such services were furnished. Based on this regulation, providers have a minimum of 15 months to a maximum of 27 months.

The time parameters are:

Dates of ServiceLast Filing Date
October 1, 2007 – September 30, 2008by December 31, 2009
October 1, 2008 – September 30, 2009by December 31, 2010
October 1, 2009 – September 30, 2010by December 31, 2011
October 1, 2010 – September 30, 2011by December 31, 2012

Claims must be submitted complete and free of errors. Any claim filed with invalid or incomplete information, and returned to the provider (RTP) for correction, is not protected from the timely filing guidelines. Medicare determines whether a claim has been filed timely by comparing the date the services were furnished (line item date or claim statement “from” date) to the receipt date applied to the claim when it is received. If the span between these two dates exceeds the time limitation, the claim is considered to have been not timely filed. When a claim is denied for having been filed after the timely filing period, such denial does not constitute an “initial determination”. As such, the determination that a claim was not filed timely is not subject to appeal.


INDUSTRY NEWS TAGS: CMS


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