decisionhealth Newsletters, Part B News - 2004 Issue 10 (October)
‘Good cause' still a way to avoid penalty for late claims
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Article Overview
This Medicare compliance article is for physicians, billing staff, and coding professionals who handle claim submission timeliness and appeals of late-filing penalties. It reviews CMS guidance on the continued availability of a good-cause exception, the kinds of circumstances CMS and a carrier may view as supporting that exception, and the documentation process carriers use when evaluating delayed claims.
Why This Topic Matters
Late filing can trigger payment reductions, so understanding the general framework for a good-cause explanation helps practices respond appropriately when a claim is submitted after the usual timeframe. The article is relevant to organizations that manage Medicare Part B billing and want to stay aligned with CMS manual guidance.
What You Will Learn
- How Medicare treats claims submitted after the normal filing period
- What kinds of circumstances CMS says may support a good-cause explanation
- How carriers are instructed to review written explanations for late claims
- Why the CMS manual update matters for late-claim penalty policy
Who Should Read This
- Physician practices
- Billing staff
- Certified professional coders
- Revenue cycle teams
- Medicare compliance staff
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