Clean Claims - Payment/Interest
A "clean" claim is one that does not require investigation or development outside the DME MAC operation on a prepayment basis.
The Medicare statute provides for claims payment "floors" and "ceilings." A floor is the minimum amount of time a claim must be held before payment can be released. A ceiling is the maximum time allowed for processing a "clean" claim before Medicare owes interest to a supplier of services.
Suppliers who file paper claims will not be paid before the 29th day after the date of receipt of their claims, i.e., a 28-day payment floor. However, clean claims filed electronically can be paid as early as 14 days after receipt, i.e., a 13-day payment floor. Interest payments will begin on the 31st day after the date of receipt for clean electronic and paper claims that are not yet paid.
The difference in payment floors is further incentive for suppliers to consider use of electronic claims submission to improve their cash flow, record keeping, and claim status tracking ability.
Last Updated Oct 16, 2018