[AndreaStark]

CMS Implements 12-Month Timely Filing Limit - Effective January 1, 2010

May 11th, 2010
If you are one of the suppliers who attended Andrea’s The Impact of H.R. 3590 on DME: How the New Healthcare Bill Affects You! webinar, or you’ve subscribed to our RSS feed and are a regular reader of MiraVista's blog, then this news will come as no surprise to you. If you’re not… then listen up!

On May 7, 2010, CMS released MLN Matters® MM6960, which reduces the timely filing limit for all Medicare claims (including all DMEPOS) to 12-months from the date of service. The 12-month timely filing limit is being implemented in accordance with provisions in H.R. 3590, the recently signed Patient Protection and Affordable Care Act (PPACA), and is effective retroactive to January 1, 2010.

The new 12-month time limit and retroactive effective date are important to DME suppliers for two reasons:
1. Claims with dates of service from October 1, 2009 through December 31, 2009 will be denied as past timely filing if received after December 31, 2010.
2. Claims with dates of service on or after January 1, 2010 will be denied as past timely filing if received more than 12-months after the service date.

In other words, you only have until the end of this year to submit any claims dated back through October of last year, and your claims for January 2010 and beyond will start denying as past timely filing within 12-months of their service dates… starting January of next year!

Because CMS has stated that claims must be “received” within 12-months, rather than submitted, you must be sure to submit your claims early enough for them to be delivered (either electronically or via postal mail) within the 12-month deadline. Per CMS, contractors will generally use a claim’s “From” date as its date of service. In cases where claims require service dates for each line item, the line item’s date will be considered the date of service.

Currently, CMS has only specified one circumstance or “exception” to the timely filing rule. In the event that a Medicare contractor, agent or employee makes an “error or misrepresentation” when handling your claim that causes it to be received late, it will not be denied for timely filing.

The PPACA does grant CMS the authority to specify additional exceptions to the 12-month filing deadline; however we do not expect there to be many, if any at all.