Anesthesia Coding Alert
Payers Need to Pay Claims Within Defined Time Frames
Question: What is Medicare’s prompt payment law? Does it specify “days” or “business days”?
New Mexico Subscriber
Answer: Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer does not pay the claim in a timely manner, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames range from 15 to 45 working days, with 30 days being about the average.
State prompt pay laws do not apply to federal insurers, because the federal government dictates that clean claims for Medicare Part B services must be paid in 30 days. The rule does not specify “30 working days” or “30 business days,” so consider the time to be a total of 30 days. If a state wants a prompt pay rule that’s longer or shorter than 30 days, they certainly can do that with reference to other payer services, but Medicare rules are federal and span across the country.
Anesthesia Coding Alert
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