Thursday, March 10, 2016

Medicare file Limit Q & A

Claims timely filing guidelines FAQ
Q: What are the claims timely filing guidelines? How can I prevent claim denials and/or rejects for untimely filing?

A: Per Section 6404 of the Patient Protection and Affordable Care Act (ACA), Medicare fee-for-service (FFS) claims for services furnished on or after January 1, 2010, must be filed within one calendar year from the date of service. Claims with dates of service January 1, 2010, and later, received more than one calendar year (12 months) from the date of service will be denied or rejected.

Key points to remember

For all claims:

• Claims with a date of service of February 29 must be filed by February 28 of the following year to be considered filed timely.
• Electronic claims -- The electronic data interchange (EDI) system accepts claims 24/7; however, claims received after 6:00 p.m., or on weekends/holidays, are considered received the next business day.
• Paper claims -- Timeliness is calculated based on contractor receipt date, not the postmark date of when the claims are mailed, so please allow time for mailing.

For Part A claims:

• For institutional claims with span dates of service (i.e., a "from" and "through" date span on the claim), the "through" date is used to determine the date of service for claim timely filing.

Exceptions allowing extension of time limit:
• Exceptions to the 12-month timely filing period are outlined in the Center for Medicare & Medicaid Services (CMS) Internet-only manual (IOM) Medicare Claims Processing Manual, Chapter 1 external pdf file.

• Click here  view the documentation needed to qualify for Part A exceptions.

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