Changes to the Time Limits for Filing Medicare Fee-For-Service Claims

The Affordable Care Act (Section 6404) reduced the maximum period for submission of all Medicare Fee-For-Service claims to no more than 12 months (one calendar year) after the date services were furnished. This time limit policy for claims submission became effective for services furnished on or after January 1, 2010. Prior to the passage of the Affordable Care Act on March 23, 2010, a provider or supplier had from 15 to 27 months (depending on the date of service) to file a timely claim. • For services furnished in the first 9 months of a calendar year, claims had to be submitted to the appropriate Medicare contractor by December 31 of the following year. • For services furnished in the last 3 months of a calendar year, claims had to be submitted to the appropriate Medicare contractor by December 31 of the second following year. Exceptions Allowing Extension of Time Limit Medicare will allow for the following exceptions to the one calendar year time limit for filing Fee-For-Service claims: • Administrative Error: This is where the failure to meet the filing deadline was caused by error or misrepresentation of an employee, the Medicare contractor, or agent of the Department that was performing Medicare functions and acting within the scope of its authority. In these cases, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the beneficiary, provider, or supplier received notice that an error or misrepresentation was corrected. • Retroactive Medicare Entitlement: This is where a beneficiary receives notification of Medicare entitlement retroactive to or before the date the service was furnished. • Retroactive Medicare Entitlement Involving State Medicaid Agencies: This is where a State Medicaid Agency recoups payment from a provider or supplier six months or more after the date the service was furnished to a dually eligible beneficiary. For example, at the time the service was furnished the beneficiary was only entitled to Medicaid and not to Medicare. Subsequently, the beneficiary receives notification of Medicare entitlement effective retroactive to or before the date of the furnished service. • Retroactive Disenrollment from a Medicare Advantage (MA) Plan or Program of All-inclusive Care of the Elderly (PACE) Provider Organization: This is where a beneficiary was enrolled in an MA plan or PACE provider organization, but later was disenrolled from the MA plan or PACE provider organization retroactive to or before the date the service was furnished, and the MA plan or PACE provider organization recoups its payment from a provider or supplier six months or more after the date the service was furnished.