October 2, 2022

Volume XII, Number 275

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September 30, 2022

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Remember Changes to Medicare Timely Filing Requirement under PPCA

CMS recently issued a reminder to Fee-For-Service physicians, providers and suppliers of its change to Medicare timely filing requirement.  The Patient Protection and Affordable Care Act (PPCA) changed this requirement so that all claims for services furnished on or after Jan 1, 2010 must be filed no later than 12 months from the date of service.  Note that the start date for determining the 1-year timely filing period is the date of service or “From” date on the claim.  For claims that include span dates of service (i.e., a “From” and “Through” date on the claim), the “Through” date on the claim is used for determining the date of service for claims filing timeliness.  For claims submitted by physicians and other suppliers that include span dates of service, the line item “From” date is used for determining the date of service for claims filing timeliness.

For more on this change, review the following MLN Matters articles:

§ MM6960 – “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” –http://www.cms.gov/MLNMattersArticles/downloads/MM6960.pdf on the CMS website.  § MM7080 – “Timely Claims Filing: Additional Instructions” http://www.cms.gov/MLNMattersArticles/downloads/MM7080.pdf on the CMS website.

You can also listen to a podcast on this subject by visiting http://www.cms.gov/CMSFeeds/02_listofpodcasts.asp on the CMS website.

©2022 von Briesen & Roper, s.cNational Law Review, Volume I, Number 33
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About this Author

von Briesen & Roper’s Health Law Section provides comprehensive legal services to the health care industry nationwide as both general counsel and special project counsel. Our clients include integrated delivery systems, academic medical centers, community hospitals, Catholic-sponsored hospitals, rural and critical access hospitals, imaging centers, physicians and multi-specialty clinics, specialty hospitals, ancillary suppliers, home health agencies, nursing homes, hospices, assisted living facilities, mental health and AODA facilities, DME suppliers, laboratories,...

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