CMS Changes the edits for timely filing denials on claims
Medicare has always had the most relaxed rules regarding timely filing. Under the old rules Medicare claims could be submitted for the last quarter of the year prior to the previous year – which means that claims for dates of service 10/1/08 or after can be submitted up to December 31st of 2010. There was a 10% penalty for any claims older than one year, but they would still be paid on. That has come to an end.
Under the new edits, claims will only be processed for payment for up to a calendar year. So for date of service June 22, 2010 the claim must be submitted prior to June 22, 2011.
The implementation of the new edits will be as follows: All claims with service dates prior to 1/1/2010 must be submitted prior to 12/31/2010 and will be processed according to the old guidelines. All dates of service 1/1/2010 and after will be subject to the new guidelines and will only be allowed within one calendar year.
This new ruling affects all Medicare provider types. It affects all physicians, providers and suppliers that submit claims to Medicare contractors including durable medical equipment suppliers, home health, Medicare Parts A & B. Basically anyone who provides services to Medicare beneficiaries and submits claims for those services.
It is important that anyone who does billing for Medicare providers understands the new edits. Much money can be lost. Don’t wait till the last minute. Begin clearing up any Medicare claims for dates of service prior to January 1st of 2010 now.
If you follow some key guidelines you should not have any problems even under the new edits. Claims should be submitted as close to the date of service as possible. If submitting electronically, electronic reports should be read and acted upon. Whether submitting on paper or electronically, follow up or aging reports should be run regularly and worked on. Any claims over 20 days if submitting electronically, and 45 days if submitting on paper should be checked on. Any denials received by Medicare should be acted upon quickly. If there is something that can be corrected, fix it and rebill quickly. If it is a patient issue, bill the patient so that they can handle anything from their end that needs to be done. This allows time to resubmit if necessary.
Honestly, the old rules were nice for us as a billing service. If we went into an office that was having billing issues we could usually recover most of their Medicare money. But with current accounts the timely filing edits didn’t effect us. Our policy is to not let claims get that old. But for offices that do not have good billing practices, the new edits may be tough.