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March 23, 2012 - Revised: 04.09.12

Medicare Timely Filing Guidelines

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.  Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year (12 months) after the date of service.

On January 21, 2011, the Centers for Medicare & Medicaid Services (CMS) announced four exceptions to the 12 month, Medicare claim filing period. The exceptions, allowing extensions of the timely filing provisions, include Administrative Error, Retroactive Medicare Entitlement, Retroactive Medicare Entitlement Involving State Medicaid Agencies and Retroactive Disenrollment from a Medicare Advantage (MA) Plan or Program of All-inclusive Care of the Elderly (PACE) Provider Organization. For more information regarding the Medicare Timely Filing Guidelines and related exceptions please visit: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7270.pdf.


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