What Is Medicare’s Timely Filing Limit?

what is medicare's timely filing limit

 

Your practice knows proper medical billing requires keen attention to detail to churn out timely, accurate claims. Careless errors result in claim rejections or denials, affecting your practice’s crucial revenue stream. One costly error is also failing to submit Medicare claims on time, resulting in a hit with a bill write-off.

So, what is Medicare’s timely filing limit?

Here’s more from PracticeForces, including why adhering to Medicare’s deadline is so critical. Notably, there is no difference in the timely filing limit for professional vs. institutional claims, so all medical billers are in the same boat with this government program.

 

How Long Do Care Providers Get to File Their Medicare Claims?

Typically, Medicare reimbursements comprise a significant portion of a medical practice’s income. Yet, the Centers for Medicare and Medicaid Services have strict rules, especially when you have to file your reimbursement claim.

What is Medicare’s timely filing limit? You have exactly one calendar year (12 months) from the date of the services provided to file a claim for reimbursement from Medicare.

If your patient sees their doctor at your practice on April 17, 2023, you will only have until April 16, 2024, to submit this claim to CMS. If the doctor fails to file on time, Medicare will not pay its share of the bill (the patient will receive it instead).

While it’s highly unlikely that responsible healthcare providers miss the deadline—a whole year is a long time—it does happen. It’s important for Medicare beneficiaries to check their Medicare account online or review their quarterly Medicare Summary Notice to confirm whether their care provider is filing timely claims, but the practice is also responsible here.

 

The Consequences of Missing Medicare’s Claim Deadline

Regardless of why it happens, missing the Medicare claim filing deadline reverts the payment responsibility to your patient. Medical services providers may refuse to file Medicare claims for various reasons. For example, they may believe CMS will deny coverage, or their practice may not be a part of Medicare.

Still, participating providers have no real reason to decline to file a Medicare claim without a good reason, and that includes requiring their patients to pay upfront or file their own claims. Under the legal framework, these actions could constitute fraud.

Providers who accept Medicare should make claims on behalf of these patients within 12 months of service. The patients can file claims on their own behalf if the deadline is near and their doctor’s medical billing department has not yet done so. To do so, they must provide documentation explaining why the provider has not submitted this claim.

Has the timely filing limit already passed and the patient received a denial notice? Appealing the decision requires gradually working through five levels to get to Medicare’s final decision.

 

Avoid Missing Deadlines With Help From PracticeForces

What is Medicare’s timely filing limit? If a whole year’s grace is already proving a challenge for your medical practice, consider getting some help. With expertise in Medicare claims, compliance, orthopedic billing guidelines, and more, PracticeForces could remove the guesswork from your medical billing and coding.

File claims on time and without incident—contact PracticeForces at (727) 499-0355.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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