CMS: PPACA Requires Change to Maximum Period of Submission Rules

The Patient Protection and Affordable Care Act (PPACA) has required a change to the maximum period allowed for providers to submit Medicare claims, according to the Centers for Medicare & Medicaid Services (CMS).

In a Medicare Learning Network (MLN) bulletin, CMS says that Medicare claims with dates of service on or after Jan. 1, 2010, will be denied if they are received by the Medicare contractor more than 12 months later.

Until this change, providers have been given significantly longer to file claims: Claims for services rendered in the first nine months of a year could be filed up to Dec. 31 of the following year. Claims for services rendered in the last three months of a year could still be filed two years later.

Under the new policy, claims with dates of service prior to Oct. 1, 2009, will continue to be handled according to pre-PPACA rules. But claims with dates of service from Oct. 1, 2009, through Dec. 31, 2009, need to be received by Dec. 31 of this year, or they will be denied by Medicare.

The MLN bulletin states, "For claims for services that require the reporting of a line item date of service, the line item date is used to determine the date of service. For other claims, the claim statement's 'From' date is used to determine the date of service."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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