The Centers for Medicare & Medicaid Services (CMS) has reminded Medicare Fee-For-Service physicians, providers and suppliers submitting claims to Medicare for payment that, as a result of the Patient Protection and Affordable Care Act (PPACA), effective immediately, all claims for services furnished on or after Jan 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.

If you have Medicare Fee-For-Service claims with service dates from Oct 1, 2009 through Dec 31, 2009, those claims MUST be filed by Dec 31, 2010, or Medicare will deny them.  Claims with service dates from Jan 1, 2009 to Oct 1, 2009 keep their original Dec 31, 2010 deadline for filing.

In general, the start date for determining the 1-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 – “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” – http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.

MM7080 – “Timely Claims Filing:  Additional Instructions” – http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org