Over Six Months have Passed Since the New Medicare Timely Filing Change -
Has this Change Impacted your Organization?
By: Kathy Ruggieri, Director, Revenue Cycle Services 

On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) and its companion bill, the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) (collectively the “PPACA).  Section 6404 of the PPACA reduced the time period for filing Medicare Fee-for-Service claims to one calendar year after the date of service, effective for services furnished on or after January 1, 2010. Prior to this change, providers and suppliers had anywhere from 15 months to as long as 27 months, depending on when the service was furnished, in which to file a claim with Medicare.  This change was one of many provisions aimed at curbing fraud, waste and abuse in the Medicare program.

CMS did clarify through MLN Matters MM7080 the following:

• For institutional claims that include a span of service (i.e. a “From” and “Through” span on the claim), the “Through” date will be used to determine timeliness.
• For professional claims submitted by physicians and other suppliers using form CMS- 1500 or 837P that include span dates of service, the “From” date will be used to determine timeliness.
• On these professional claims, if a “From” date is not timely, but the “To” date is timely, the Medicare contractors will split the line item and deny untimely services as not timely filed.
• Claims having a date of service of February 29^th must be filed by February 28^th of the following year to be considered timely.  If the date of service is February 29^th of any given year, and is received on or after March 1^st of the following year, the claim will be denied as having failed to meet the timely filing requirement.  

CMS will allow the following few exceptions to the one-calendar-year time limit.  These exceptions were outlined in MLN Matters MM7270:

• 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.  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.  For example, at the time services were furnished the beneficiary was not entitled to Medicare.  However, after the timely filing period expired, the beneficiary receives notification of Medicare entitlement effective retroactive to or before the date of the furnished service.  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 notification of Medicare entitlement retroactive to or before the date of the furnished service.
• Retroactive Medicare Entitlement Involving State Medicaid Agencies
  
  • This is where the State Medicaid Agency recoups payment from a provider or supplier six months or more after 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 Medicare.   Subsequently the beneficiary receives notification of Medicare entitlement retroactive to or before the date of service.   The state Medicaid agency recoups their payment from the provider or supplier and the provider or supplier cannot submit the claim to Medicare because the time limit has expired.  Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the state Medicaid Agency recovered its payment from a provider or supplier.
• 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 a Medicare Advantage plan or PACE provider organization, but later was dis-enrolled from the Medicare Advantage plan or PACE provider organization retroactive to or before the date the service was furnished and the Medicare Advantage plan or PACE provider organization recoups its payment from a provider or supplier six months or more after the date the service was furnished.  In these cases, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the Medicare Advantage or PACE organization recovered its payment from a provider or supplier.

Once a claim is submitted to Medicare there are opportunities to adjust claims outside of timely filing in certain situations.  However, it is paramount that an initial claim be submitted timely.

The Bottom Line

The recent change in timely filing is significant for providers who were accustomed to the flexibility of having 15 – 27 months to submit their claims.  Although CMS has allowed some exceptions, there are very few exceptions for the everyday internal disconnects that challenge providers.   Now that over six months have passed since the implementation of this change, it is important for providers to not only concurrently assess the impact of the change to their specific organizations, but to implement or fine tune controls if needed to ensure claims are billed timely.   Here are a few suggestions:

• Routinely track untimely denials and share this information internally within all levels of your organization through task forces and internal meetings.   Since there is a unique denial code designating a timely filing denial, automated reports can be run identifying these claims.
• Research each specific claim denial and provide education to the key areas where the delay occurred as process changes may be needed.
• Routinely track claims that are not billed to Medicare because they exceed timely filing and include these claims in your internal reporting.
• Enhance tracking mechanisms of Medicare aged claims approaching timely filing deadlines.
• Continue to educate all staff, including physicians.  Timely coding and billing are essential components to the elimination of timely filing rejections.

Teaching providers who submit shadow bills to Medicare are also required to comply with this new timely filing change.  Many teaching providers have been challenged with this new change and have experienced timely filing rejections. Here are a few suggestions for teaching providers entitled to additional IME and GME reimbursement:

• Do not wait for payment from the Medicare Advantage plan to submit the shadow bill for IME reimbursement.   Medicare shadow bills should be billed concurrently at the time the Medicare Advantage plan is billed.  In the event a claim should not have been billed to Medicare, an adjustment claim can be submitted.
• Conduct a retrospective review either quarterly or bi-annually to detect additional accounts that were not identified through established processes.  This will ensure all IME and GME revenue that a teaching facility is entitled to is obtained.

In today’s challenging fiscal environment, it is imperative that facilities ensure they are closely monitoring these types of changes as they occur to ensure revenues are not lost.

BESLER Consulting provides a variety of IME and GME reimbursement services to help ensure revenues are not lost. For more information please contact Kathy Ruggieri at 732.392.8227 or kruggieri@besler.com.

CMS MLN Matters MM7270, Related CR Transmittal #R2140CP
CMS MLN Matters MM7080, Related CR Transmittal #R734OTN