Health Information Management

Healthcare News: CMS reduces timely filing limit to 12 months

JustCoding News: Inpatient, May 26, 2010

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CMS reduced the timely filing limit for submitting Part A and B claims to Medicare to comply with the Patient Protection and Affordable Care Act (PPACA). Medicare will deny claims with dates of service on or after January 1, 2010 received later than one calendar year beyond the date of service, according to MLN Matters article MM6960.

This is a change from the previous requirements, which allowed providers to submit Part A and Part B claims by the end of the calendar year that followed the fiscal year in which the service was furnished.
MLN Matters article MM6960 states the following:

Medicare contractors are adjusting (as necessary) their relevant system edits to ensure that:

  • Claims with dates of service prior to October 1, 2009 will be subject to pre-PPACA timely filing rules and associated edits
  • Claims with dates of service October 1, 2009 through December 31, 2009 received after December 31, 2010 will be denied as being past the timely filing deadline
  • Claims with dates of service January 1, 2010 and later received more than one calendar year beyond the date of service will be denied as being past the timely filing deadline

Note: For claims for services that require the reporting of a line item date of service, the line item date is used to determine the date of service. For other claims, the claim statement’s “From” date is used to determine the date of service.

HIM staff members should help alert billers to this important change.



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