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 (1) calendar year (12 months) beyond the date of service will be denied/rejected as being past the timely filing deadline. 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 filing timeliness.
CMS allows four (4) exceptions to the 12 month, claim filing period. These include Administrative Error, Retroactive Medicare Entitlement, Retroactive Medicare Entitlement Involving State Medicaid Agencies and Retroactive Disenrollment from a Medicare Advantage (MA) Plan or Program of All-inclusive Care of the Elderly (PACE) Provider.
For further details related to timely filing and the exceptions, visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7270.pdf.
Last updated: September 4, 2013