General Category > General Questions

Late filing rules and penalties

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dwinterton:
I just saw on a Medicare Summary Notice that "Payment was reduced for late filing. You cannot be billed for the reduction." What are the filing requirements to avoid this action?

Pay_My_Claims:
Medicare Claim Filing Deadlines:

Mandatory Submission of Claim:
The Centers for Medicare and Medicaid Services requires that all
participating or non-participating providers must submit claims on
behalf of the Medicare Beneficiary who are enrolled in Medicare
Part B and who has provided covered care to the Beneficiary. This
is a mandatory law which became effective in September 1990.

The filing time limitation for Medicare claims is a 15 to 27 month
period. Meaning, claims can be submitted for the current calendar
year, the entire prior calendar year and the three-month period –
October through December of the calendar year prior to that.

Example:
Date of Services between:                                   Must be submitted by:

October 1, 2005 and September 30, 2006                        December 31, 2007
October 1, 2006 and September 30, 2007                        December 31, 2008
October 1, 2007 and September 30, 2008                        December 31, 2009



**** For more information: Visit the CMS website (cms.gov).

Michele:
To avoid the late filing charge the service must be < one year old.  So claims processed today for any service date from 10/01/2007 thru 7/28/08 would receive the late filing penalty.

Michele

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