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Maximum Period for Submission of Medicare Claims Reduced to Not More Than 12 Months

On May 7, 2010, CMS promulgated Transmittal 697 to align the requirements governing the timely filing limits (for submitting claims for Medicare Fee-for-Service (“FFS”) reimbursement) with the requirements set forth in the Patient Protection and Affordable Care Act (the “PPACA”).

By way of background, a service provider or supplier formerly had been required to submit the claim for services furnished on or before December 31 of the following year for dates of service occurring during the first nine (9) months of the year. For services furnished during the last quarter of the calendar year, the provider or supplier needed to submit the claim on or before December 31st of the second following year. Thus, in practice, providers and suppliers had 15 to 27 months to file Medicare FFS claims.

Section 6404 of PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service, effective for services furnished on or after January 1, 2010. For example, if a service is furnished on May 15, 2010, then the claim must be submitted to Medicare no later than 15, 2011. Additionally, this section mandates that all claims for services furnished prior to January 1, 2010 must be filed with the appropriate Medicare Administrative Contractor (MAC) no later than December 31, 2010. Transmittal 697 instructs the MACs to implement these changes to the timely filing requirements prescribed by 6404 of PPACA. Although not certain, we at THE HEALTH LAW PARTNERS consider it likely that CMS will adopt a rule interpreting the new timely filing requirement. In the interim, it is incumbent upon all providers and suppliers to review their claims submission practices to ensure compliance with Transmittal 697.

For more information regarding this topic or other recent developments in health law, please call us at (248) 996-8510 or visit The HLP website.

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