Industry News: Timely Filing Requirement from the Patient Protection and Affordable Care Act (PPACA)
December 21st, 2010

Taken from the recent CMS announcement:

Effective immediately, the Centers for Medicare & Medicaid Services (CMS) would like to remind Medicare fee-for-service physicians, providers and suppliers, who are submitting claims to Medicare for payment, all claims for services furnished on or after January 1, 2010, must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service or Medicare will deny them. This is a result of the Patient Protection and Affordable Care Act (PPACA).

•If you have Medicare fee-for-service claims with service dates from October 1, 2009, through December 31, 2009, those claims must be filed by December 31, 2010, or Medicare will deny them

•Claims with service dates from January 1, 2009, to October 1, 2009, keep their original December 31, 2010, deadline for filing.

In general, the start date for determining the one-year timely filing period is the date of service or 'From' date on the claim. For institutional claims that include span dates of service (i.e., a 'From' and 'Through' date on the claim), the 'Through' date on the claim is used for determining the date of service for claims filing timeliness. For claims submitted by physicians and other suppliers that include span dates of service, the line item 'From' date is used for determining the date of service for claims filing timeliness.

For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor or review the MLN Matters articles listed below related to this subject:

•MM6960 (PDF, 70 KB) – 'Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404 - Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months'

•MM7080 (PDF, 73 KB) – 'Timely Claims Filing: Additional Instructions 

Posted by Bryan Fryar in CMS Announcements for Home Health

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