The Centers for Medicare and Medicaid Services (CMS) recently advised providers that, pursuant to the Patient Protection and Affordable Care Act (PPACA), Medicare fee-for-service (FFS) claims with dates of service on or after January 1, 2010 that are received later than one calendar year beyond the date of service will be denied by Medicare.

Prior to PPACA, providers were permitted to submit claims for services furnished during the first nine months of the calendar year on or before December 31st of the following calendar year. For services furnished during the final three months of the calendar year, the provider could submit claims on or before December 31st of the second following year. PPACA reduces the maximum time for submission of all FFS claims to one calendar year after the date of service.

Furthermore, in accordance with section 6404 of PPACA, claims with dates of service before January 1, 2010 must be filed with Medicare contractors no later than December 31, 2010. Although CMS states that claims with dates of service prior to October 1, 2009 are subject to pre-PPACA filing rules, the December 31st deadline effectively applies to these claims because the dates of service fall within the first nine months of 2009. Thus, they must be submitted by December 31st of the following calendar year, or December 31, 2010.  

CMS asserts the following system edits will apply

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One exception currently exists for the timely filing limitations: an "error or misrepresentation" of an employee, Medicare contractor or agent. CMS intends to issue further instructions if additional exceptions are adopted.