Neurology & Pain Management Coding Alert

Question: During a recent internal review, we found several claims from November 2009 that were never filed with Medicare. Can we still submit these claims for payment?

New York Subscriber

Answer: Unfortunately, the claims lay unseen for too long so you're out of luck in terms of reimbursement.

Here's why: Medicare now has a one-year timely filing limit, which says that claims with dates of service on or after January 1, 2010 must be received no later than one calendar year after the date of service. If the date of service is more than one year past, Medicare will deny the claim.

Exception: Notice that the timely filing rules specifies claims with service dates on or after January of this year. Your claim is from 2009 so the guidelines are a bit different. According to MLN Matters article MM6960, "Claims with dates of service October 1, 2009 through December 31, 2009 received after December 31, 2010 will be denied as being past the timely filing deadline." Therefore, you had until December 31, 2010 to get your claim submitted. Since you miss that deadline, your claim would be denied.