Home Health & Hospice Week

Watch out: Under timely filing rules you may have only 10 months instead of 12 to submit your Medicare claims.

Why? As of Jan. 1, CMS requires providers to submit claims within 12 months of the date of service. The agency clarified that for home health agency claims, the 12-month window will be counted from the "through" date.

However, Medicare billing instructions require agencies to use the same "from" and "through" date on the request for anticipated payment (RAP), points out the National Association for Home Care & Hospice in its member newsletter. Because "a final claim cannot be processed without a corresponding RAP in the system ... home health agencies are essentially being 'shorted' by two months of the one-year timely filing period," the trade group warns.

In other words, a final claim with a "through" date within the 12-month window can't be processed if a corresponding RAP with a date outside the 12-month window is rejected.

CMS won't be able to install a system fix for this problem any earlier than October 2011, the agency reportedly tells NAHC. "Until that time, home health agencies will be expected to continue to submit RAPs as usual, but they should understand that any RAP with dates beyond one year of filing will not process and, therefore, neither will the associated final claim," the trade group says.