Health Care Reform Law Amends Timeframe for Filing Medicare Claims

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law as part of ongoing health care reform.  This legislation provides amendments to the time period for filing Medicare Fee-For-Service (FFS) claims.  Pursuant to section 6404 of the Act, the maximum time period for submission of all Medicare FFS claims has been reduced to “one calendar year after the date of service.”  Previously, the maximum timeframe for claims submission was three years.

Under the new law, the deadlines for submission of Medicare FFS claims are as follows:

Date of Service Deadline to File Claim
Before October 1, 2009 Pre-PPACA timely filing periods apply
October 1, 2009 – December 31, 2009 December 31, 2010
On or After January 1, 2010 One calendar year from the date of service

 Appeals & Penalties

Any claims filed after the relevant deadline will be denied, and there are no appeals when claims are denied for untimely filing.  Moreover, any assigned claims that are submitted after the respective deadline has passed will be subject to a 10% reduction of the amount that would otherwise have been paid.  This 10% penalty may not be charged the beneficiary.

 Exceptions

In the event that a provider cannot file a claim within the appropriate timeframe due to a Medicare administrative error, the time limit will be extended to six months following the month in which the error is rectified by notification to the provider or beneficiary.  According to the Centers for Medicare & Medicaid Services (CMS), “administrative error” may include “misrepresentation, delay, mistake, or other action of Medicare, or its FIs or carriers or SSA.”

Section 6404 of the Act also authorizes the HHS Secretary to make exceptions to the one year time period.  No further exceptions have been made to date.