CMS finalizes new timely claims rule for practices

by: CHARLES FIEGL May 10, 2010

A Medicare claim must be submitted within 12 months of the date of service or it will be rejected, CMS states in a transmittal released Friday. The change is mandated by the health care reform law (the Patient Protection and Affordable Care Act or PPACA).

Physicians treating Medicare patients no longer have up to 26 months to file a claim. A claim for a service provided on March 15, 2010 must be submitted for payment by March 15, 2011.

The timely claims change is effective immediately. Claims for services provided before Dec. 31, 2009, will now need to be submitted by Dec. 31, 2010, CMS says. Otherwise sending a claim outside the 12-month window will result in a rejection. The Claim Adjustment Reason Code (CARC) 29 will appear on a remittance when a claim for a service is received a year after the service was rendered. CARC 29 simply means "The time limit for filing has expired."

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