System Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404- Maximum Period for Submission of Medicare Claims Reduced to Not More than 12 Months

Wisconsin Physician Services (an existing Medicare Carrier and Medicare Administrative Contractor) issued a reminder today on its website for providers concerning the new deadlines for Medicare claims submission. The CMS Medlearn matters article dated May 7, 2010 and effective January 1, 2010 on the subject provides specific details relative to the topic.

For example, Section 6404 of the PPACA has amended the timely requirements to reduce the maximum time period of submissions of all Medicare Fee-For-Service (FFS) claims to one calendar year after the date of service. Additionally Section 6404 mandates that all claims for services furnished prior to January 1, 2010 must be filled with the appropriate Medicare claims processing contractor no later than December 31, 2010.

Section 6404 will impact all physicians, providers, and suppliers submitting claims to Medicare contractors for services to Medicare beneficiaries. Currently, Medicare contractors are adjusting their relevant system edits to ensure that claims with dates of service prior to October 1, 2009 will be subject to a pre-PPACA timely filling rules and associated edits.

While section 6404 does authorize CMS to make specific exceptions to the timely filing requirement, currently, the only exception is found in the filing regulations at 42 CFR section 424.44(b)(1), for “error or misrepresentation” of an employee, Medicare contractor, or agent of the Department that was performing Medicare functions.

For more information on this topic, feel free to contact Adrienne Dresevic Esq. or Carey F. Kalmowitz, Esq. of The Health Law Partners at (248) 996-8510 or (212) 734-0128.