Timely Filing - JE Part B

As a result of the Patient Protection and Affordable Care Act (PPACA), all claims for services furnished on/after January 1, 2010, must be filed with your Medicare Administrative Contractor (MAC) no later than one calendar year (12 months) from the date of service (DOS) or Medicare will deny the claim.

• In general, start date for determining 1-year timely filing period is DOS or "From" date on claim
  • Claims with a February 29 DOS must be filed by February 28 of following year to meet timely filing requirements
• For institutional claims that include span DOS (i.e., a "From" and "Through" date on claim), "Through" date on claim is used for determining DOS for claims filing timeliness
• For claims submitted by physicians and other suppliers that include span DOS, line item "From" date is used for determining date of service for claims filing timeliness

A claim that is denied because it was not filed timely is not afforded appeal rights. See the CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 70.

Medicare regulations, 42 CFR 424.44, allow that where a Medicare program error causes the failure of a provider to file a claim for payment within the time limit in section 70.1, the time limit will be extended through the last day of the sixth calendar month following the month in which the error is rectified by notification to the provider or beneficiary.

If a claim is denied for timely filing as the result of an administrative error due to a government agency, such as a Medicaid agency recouping money due to Medicare entitlement by the patient at the time of the service or an error with the patient's Social Security Administration (SSA) entitlement, the claim(s) may be resubmitted with a comment in Item 19 of the CMS-1500 claim form (or electronic equivalent) that indicates there was an administrative error. The comment in Item 19 for Medicaid recoupments should state "Medicare Buy Back" and for SSA retroactive entitlements, the comment should state "SSA Error-Retroactive Entitlement."

Paper claims should include a copy of the letter that indicates the date range for the claims involved or the effective date of the Medicare entitlement. Claims must be submitted by the last day of the sixth calendar month following notification that the error has been corrected by the government agency. The timely filing limit cannot be extended beyond December 31 of the third calendar year after the year in which the services were furnished. (For services furnished during October – December of a year, the time limit may be extended no later than the end of the fourth year after that year.)

Resources

• CMS Change Request (CR) 6960 - 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
• CMS CR 7080 - Timely Claims Filing: Additional Instructions
• CMS CR 7270 - Changes to the Time Limits for Filing Medicare Fee-For-Service Claims
• CMS CR 7834 - Modifying the Timely Filing Exceptions on Retroactive Medicare Entitlement and Retroactive Medicare Entitlement Involving State Medicaid Agencies