Medicare’s New Timely Filing Rules

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.


8 Responses to “Medicare’s New Timely Filing Rules”

  1. Chandrasheker Boreda Says:

    Please send me the new updates in medical billing and also coding

  2. Chandrasheker Boreda Says:

    In MLN online trainings its says that the time limit is more than one callender.
    For example: If the DOS is Jan – Sep -2008 then the claim sibmitted by Dec-31 -2009

    For Example : If the DOS is Oct- Dec- 2008 then the claim submitted by Dec -31–2010

    • solutionsmedicalbilling Says:

      I’m not familiar with MLN online trainings, but the official ruling from Medicare is beginning 1/1/2010 it will be one year. Any services prior to 1/1/2010 go by the old ruling, so that is correct, DOS after 10/1/2008 have until 12/31/2010 to be submitted. anything prior to 10/1/2008 would have had to be in by 12/31/2009.

  3. neema chaudhari Says:

    Hi, i just want to know how this new Medicare time billing process affects to provider and any benefits for the patient that is shown by this law?

    • solutionsmedicalbilling Says:

      There is really no benefit or harm to the patient with this new law. It affects the provider because the provider now has a smaller time frame in which to get claims paid. It will require providers to be more diligent in filing Medicare claims, and handling any denials or resubmitting any claims.

  4. robert Says:

    I had a claim processed by a hospital in Texas in 5/23/2008. They had billed my secondary insurance instead of medicare first. My secondary paid off bill and then retracted payment 2 years later because Medicare should of paid off first. Now Medicare won’t pay the bill at all and Hospital lost appeal. They want to hold me responsible. I was in ER while my daughter was producing medicla coverage ID. They claim they never saw Medicare ID. What am I to do?

    • solutionsmedicalbilling Says:

      Wow, that is a tough position. Was your daughter aware of the fact that you had Medicare and does she recall if she gave them your Medicare card? If she is sure she notified them then I would dispute the bill. If they will not work with you, you can call Medicare and ask what you can do. If they are a Medicare facility, and they are not following Medicare rules, Medicare will contact them on your behalf.

      Best of Luck!

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