Healthcare Reform Legislation Changes Medicare Timely Filing Requirements

The Patient Protection and Affordable Care Act (PPACA), also referred to as the Healthcare Reform Legislation, made significant changes for Medicare providers. One change found in Section 6404 of the PPACA reduces the Medicare Parts A and B claims filing deadline to one (1) calendar year after the date of service furnished on or after January 1, 2010. The Section also gives the Secretary of the Department of Health and Human Services discretion to specify “exceptions” to the filing deadline. However, the PPACA did not specify the exceptions and it will be necessary to wait until the Centers for Medicare and Medicaid Services (CMS) begins the rulemaking process to implement the new filing deadlines. Regardless of the lack of specification of the exceptions to the filing deadlines, the new timely filing deadlines are self-executing.

It is also important to note that Section 6404 of the PPACA alters the timely filing deadline for claims under Medicare Parts A and B with dates of service prior to January 1, 2010. Claims with dates of service prior to January 1, 2010 must be filed by December 31, 2010.

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