Timely Filing of Medicare Claims

President Obama’s signing of the Patient Protection and Affordable Care Act (PPACA) received a lot of attention by the media, general public, and health care providers. Since the signing on March 23, 2010, providers have asked how this affects their day-to-day operations. The information is beginning to surface. One change relates to the timely filing requirements for Medicare fee-for-service claims.

Prior Medicare rules and regulations provided for a minimum of 15 months to a maximum of 26 months to file a claim. The range depended on when the service occurred. For example, September encounters had to be filed within 15 months but October encounters had 26 months.

The PPACA revises the old regulation and requires that for all services provided on or after January 1, 2010, be filed within one calendar year after the date of service. In addition, it stipulates that all services provided prior to January 1, 2010 be filed before December 31, 2010. Claims with dates of service before October 1, 2009 will utilize the old timely filing rules. Dates of service October 1, 2009, through December 31, 2009, must be submitted by the end of 2010.

Claim Filing Deadlines:

Before October 1, 2009 (follow old rules)…… File before 12/31/10
October 1, 2009 – December 31, 2009……… File before 12/31/10
January 1, 2010 and future………………………. File within 12 months from date of service

Stay tuned for more information of how the PPACA affects operations.

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