Wiki Medicare denying claims submitted after TFL

[Biller2023]

During the pandemic, we couldn't send claims to medicare on time so we submitted it after their Timely filing limit and they got denied for TFL. We tried appealing with the valid reason that we were short staffed and couldn't send claims on time during the pandemic but still Medicare denied to make payments. Is there any suggestion on how we can have Medicare make payments for the claims that were not submitted on time. We were also not aware that we need to use MBI number starting Jan 2020 and we submitted all the claims with Patients' old medicare#. We recently changed the MBI number and resubmitted them but all of them got denied for TFL and the appeals were also upheld. So, is there anyway Medicare will accept these claims submitted after TFL if we have valid reasons like mentioned above. Thank you!

 

[tbragg36]

This is a tough one. MACs are usually very firm. OK, here we go:
1. What level of appeal are you on? Usually, first and most part second-level appeals for TFL are denied.
2. I didn't see a mention of what type of treatment was given. Can you send in documentation showing the medical necessity IF the treatment wasn't given, it could have been detrimental to the patient's health.
3. This link is for group plans, but it might help with Medicare. You could use a phrase or two for an appeal letter. https://www.federalregister.gov/doc...plans-participants-and-beneficiaries-affected
4. https://www.cms.gov/files/document/cms-waivers-and-covid-19-response.pdf
5. By what you said, none of the denied claims were sent to Medicare during covid. There could be some internal software tracking system you could send with your appeals verifying either you tried to send claims or showing treatment was given.

If I think or see anything else, I'll post it for you.
Good Luck