Changes made to Timely Filing Requirements for Medicare Fee-For-Service Claims

On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.

Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service.

In addition, the law mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. 

The following rules apply to claims with dates of service prior to January 1, 2010.

· Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules.

· Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010. 

The PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. 

However, at this time, no exceptions have been established.  However, proposals for exceptions will be specified in future proposed rulemaking.

For guidance on this issue, contact us through the Third Party Insurance Help Program.

-----------------------------------------------------

James A. McNally, CPC

Health Care Consultant Services