decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 3 (March)
Medicare stops the clock for “other-than-clean” claims
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Article Overview
This article covers a CMS update on how Medicare contractors count the statutory 45-day timeframe for claims that are not considered clean and require additional development. It is relevant to billing staff, coders, and claims administration teams who want to understand the general processing framework, the affected Medicare guidance, and the timing mechanics described by CMS.
Why This Topic Matters
Knowing when Medicare pauses and resumes the processing clock can help practices track claim status more accurately and manage follow-up on claims that need additional information.
Article Sections
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Claims-processing timing update
Introduces a Medicare change affecting how certain claims are counted for processing purposes and why the update was issued.
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CMS definitions and guidance sources
Summarizes the CMS materials referenced in the article and the general definitions used for claims that need additional contractor review.
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How the 45-day timeframe is counted
Explains the updated timing framework for claims that require additional information and the point at which counting resumes.
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Example of the timing process
Provides a brief illustrative scenario showing how the revised counting method works in practice.
What You Will Learn
- Which Medicare guidance documents are discussed in the update
- How the article characterizes claims that need additional contractor review
- What general change CMS made to the timing of claim processing
- How the article illustrates the revised counting process
Who Should Read This
- Medical coders
- Billing staff
- Claims follow-up teams
- Practice managers
- Revenue cycle professionals
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