CMS Clarifies Timely Filing Requirements for Claims Including a Span of Time

CMS has issued new guidance expanding on the Fee-for-Service Reimbursement instructions detailed in CR 6960 (which HLP had blogged about here). The earlier change request explained the basic standards stemming from the Section 6404 of the Patient Protection and Affordable Care Act of 2010: services billed more than one year after they were provided would be considered untimely filed and would not be paid.

The new CR 7080, explained in the MLN Matters 7080, sets forth instructions for timely billing for claims that span dates of service (i.e., “from… through…”). In particular, for institutional services, the one-year deadline will be based on the “through” date (the final date included in the claim). For professional services, the one-year deadline will be calculated on the “from” date.

For more information on Medicare reimbursements, contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128, visit the RAC specialty page, or the HLP website.