Timely Filing of Claims

To be eligible for Medicare reimbursement, claims must be filed within a qualifying time limit. Claims must be filed with Medicare by the end of the calendar year following the Fiscal Year, which runs from October to September, in which the services were provided, or the claim will be denied. To summarize, at least 15 months from the date of service are allowed for filing claims.

*Note: If a claim is filed more than one year from the date of service, payment to the physician or supplier will be reduced for that service by 10%. The provider cannot bill the patient for this reduction. The patient may only be charged 20% of the amount that Medicare would have approved for the service.

Failure to File within Time Limits
Valid claims not filed within the time limits are denied. The provider cannot collect the actual charge for the service from the patient when an assigned claim is denied for late filing. When the provider accepts assignment but fails to submit a valid claim within the filing limit, the patient may only be charged 20 percent of Medicare's approved amount.

Page Last Updated: Friday, 06-Nov-2009 14:04:45 CST