tci Medicare Compliance & Reimbursement - 2018 Issue 10
Reader Question: Timely Claims Get Paid — Late Claims Do Not
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Article Overview
This short reader-question article addresses Medicare claims timeliness for fee-for-service billing and the consequences of submitting a claim after the allowed filing window. It is relevant to billing staff, coders, and revenue cycle teams who need a general understanding of filing deadlines, provider liability, and the existence of CMS-recognized exception categories. The article also points readers to CMS guidance for more information on the exception types.
Why This Topic Matters
Late submission can affect whether a Medicare claim is considered payable and whether the provider may be held responsible for the charge. Understanding the filing window and the broad exception categories helps practices reduce avoidable denials and follow Medicare billing requirements.
What You Will Learn
- How Medicare fee-for-service claim filing timeliness is framed in general terms
- What happens when a claim is submitted outside the allowed filing period
- That CMS recognizes limited categories of exceptions to the standard filing rule
- Where to look for additional CMS guidance on claims time exceptions
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Practice managers
- Compliance staff
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