If a proper claim is submitted, but it’s not within the timing window, it may result in a denial. Medicare providers should be aware that the Affordable Care Act reduced the claims-submittal period from between 15 and 27 months down to 12 months. The start date for a Medicare claim is the date the service is provided to the patient or the “From” date on the claim form. The claim must be received by the appropriate Medicare claims processing contractor before the end date (exactly one calendar year after the start date). If a claim is sent before the end date but received after, it will be denied. It is vital that you understand the process of addressing timely issues.
The understanding of what to submit for supporting documentation to receive reimbursement is critical to appealing timely issues. You will not be reimbursed for the services denied timely if you do not understand how to handle them. Commercial and Medicare have different guidelines that are considered timely filing. Per Section 6404 of the Patient Protection and Affordable Care Act (ACA), Medicare fee-for-service (FFS) claims services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. Claims with dates of service January 1, 2010, and later received more than one calendar year (12 months) beyond the date of service will be denied and/or rejected as being past the timely filing deadline.