If the claims are not submitted within the above timeframes, payment may be withheld in accordance with CMS guidelines.

Transcription

1 Dear Physicians and Practitioners, Per LN article 6960 titled ystems hanges Necessary to mplement the Patient Protection and ffordable are ct (PP) ection aximum Period for ubmission of edicare laims educed to Not ore Than 12 onths and 6960, Under the PP (Patient Protection and ffordable are ct), which does apply to Blue ross and Blue hield of Georgia by virtue of the P Terms and onditions, providers must submit claims as follows: laims with DO prior to 10/1/2009 must follow the previous timely filing guideline laims with DO 10/1/ /31/2009 must be filed by 12/31/2010 laims with DO 1/1/2010 and forward, must be filed within one calendar year of the DO f the claims are not submitted within the above timeframes, payment may be withheld in accordance with guidelines. Please see the article for more specific background and details. Thank you, enior Provider Outreach Blue ross and Blue hield of Georgia, nc., is an independent licensee of the Blue ross and Blue hield ssociation. The Blue ross and Blue hield names and symbols are registered marks of the Blue ross and Blue hield ssociation.

2 News lash The pril 2010 Edition of the edicare Learning Network (LN) atalog of Products is now available and may be accessed at on the website. The LN Products atalog is an interactive downloadable document that lists all edicare Learning Network products by media format. The catalog has been revised to provide new customer-friendly links that are embedded within the document. ll product titles and the word "download" when selected, will link you to the online version of the product. The word "hard copy" when selected, will automatically link you to the LN Product Ordering page. To access the catalog, click on the link called LN Product atalog. LN atters Number: 6960 elated hange equest () #: 6960 elated elease Date: ay 7, 2010 Effective Date: January 1, 2010 elated Transmittal #: 697OTN mplementation Date: October 4, 2010 ystems hanges Necessary to mplement the Patient Protection and ffordable are ct (PP) ection aximum Period for ubmission of edicare laims educed to Not ore Than 12 onths Provider Types ffected Provider ction Needed This issue impacts all physicians, providers, and suppliers submitting claims to edicare contractors (carriers, durable medical equipment edicare administrative contractors (DE s), fiscal intermediaries (s), Part /B edicare administrative contractors (/B s), and/or regional home health intermediaries (HHs)) for services provided to edicare beneficiaries. The enters for edicare & edicaid ervices () is updating edit criteria related to the timely filing limits for submitting claims for edicare ee-for-ervice () reimbursement. s a result of the PP, claims with dates of service on or after January 1, 2010 received later than one calendar year beyond the date of service will be denied by edicare. urther details follow in this article. ake sure your billing staff is aware of these changes. Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. t is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. Page 1 of 3

3 LN atters Number: 6960 elated hange equest Number: 6960 Background What You Need to Know ections 1814(a), 1835(a)(1), and 1842(b)(3) of the ocial ecurity ct as well as the ode of ederal egulations (), 42 ection specify the timely filing limits for submitting claims for edicare ee-or-ervice () reimbursement. Prior to PP, the regulations stated the service provider or supplier must submit claims for services furnished during the first nine (9) months of the calendar year on or before December 31 st of the following calendar year. or services rendered during the last quarter of the calendar year, the provider or supplier must submit the claim on or before December 31 st of the second following year. ection 6404 of PP amended the timely filing requirements to reduce the maximum time period for submission of all edicare claims to one calendar year after the date of service. dditionally, this section mandates that all claims for services furnished prior to January 1, 2010 must be filed with the appropriate edicare claims processing contractor no later than December 31, edicare contractors are adjusting (as necessary) their relevant system edits to ensure that: laims with dates of service prior to October 1, 2009 will be subject to pre- PP timely filing rules and associated edits; laims 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 and; laims with dates of service January 1, 2010 and later received more than 1 calendar year beyond the date of service will be denied as being past the timely filing deadline. NOTE: or claims for services that require the reporting of a line item date of service, the line item date is used to determine the date of service. or other claims, the claim statement s rom date is used to determine the date of service. ection 6404 of PP gives the authority to specify exceptions to the one (1) calendar year time limit for filing claims. urrently, there is one exception found in the timely filing regulations at 42 section (b)(1), for "error or misrepresentation" of an employee, edicare contractor, or agent of the Department that was performing edicare functions and acting within the scope of its authority. f adds additional exceptions or modifies the existing exception Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. t is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. Page 2 of 3

4 LN atters Number: 6960 elated hange equest Number: 6960 dditional nformation to the timely filing regulations, specific instructions will be issued at a later date explaining those changes. f you have questions, please contact your edicare, arrier, DE, /B and/or HH at their toll-free number which may be found at on the website. The official instruction (6960) issued to your edicare, arrier, DE, /B and/or HH is available at on the website. Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. t is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. Page 3 of 3

5 anual ystem Pub One-Time Notification Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 697 Date: ay 7, 2010 hange equest 6960 UBJET: ystems hanges Necessary to mplement the Patient Protection and ffordable are ct (PP) ection aximum Period for ubmission of edicare laims educed to Not ore Than 12 onths. UY O HNGE: The time period for filing edicare claims is specified in sections 1814(a), 1835(a)(1), and 1842(b)(3) of the ocial ecurity ct and in the ode of ederal egulations (), 42 ection ection 6404 of the Patient Protection and ffordable are ct (PP) amended the timely filing requirements to reduce the maximum time period for submission of all edicare claims to one calendar year after the date of service. EETVE DTE: January 1, 2010 PLEENTTON DTE: October 4, 2010 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. HNGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED-Only One Per ow. /N/D HPTE / ETON / UBETON / TTLE N/. UNDNG: or iscal ntermediaries (s), egional Home Health ntermediaries (HHs) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

6 V. TTHENT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

7 ttachment One-Time Notification Pub Transmittal: 697 Date: ay 7, 2010 hange equest: 6960 UBJET: ystems hanges Necessary to mplement the Patient Protection and ffordable are ct (PP) ection aximum Period for ubmission of edicare laims educed to Not ore Than 12 onths Effective Date: January 1, 2010 mplementation Date: October 4, GENEL NOTON. Background: ections 1814(a), 1835(a)(1), and 1842(b)(3) of the ocial ecurity ct as well as the ode of ederal egulations (), 42 ection specify the timely filing limits for submitting claims for edicare ee-for-ervice () reimbursement. s indicated in the regulation, the service provider or supplier must submit the claim for services furnished on or before December 31 of the following year for dates of service occurring during the first nine (9) months of the year. or services furnished during the last quarter of the calendar year, the provider or supplier must submit the claim on or before December 31 st of the second following year. ection 6404 of PP amended the timely filing requirements to reduce the maximum time period for submission of all edicare ee-for-ervice claims to one calendar year after the date of service. These amendments apply to services furnished on or after January 1, dditionally, this section mandates that all claims for services furnished prior to January 1, 2010 must be filed with the appropriate edicare claims processing contractor no later than December 31, B. Policy: edicare contractors shall adjust (as necessary) all relevant system edits so that: 1) claims with dates of service prior to October 1, 2009 will be subject to pre-pp timely filing rules and associated edits; 2) 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 statute and; 3) claims with dates of service on or after January 1, 2010 received more than 1 calendar year beyond the date of service will be denied as being past the timely filing statute (ex: claim DO = 3/15/10, claim must be received by OB 3/15/11). laims for services that require the reporting of a line item date of service, the line item date is used to determine the date of service. or other claims, the claim statement s rom date is used to determine the date of service. ection 6404 of PP gives the authority to specify exceptions to the one (1) calendar year time limit for filing claims. urrently, there is one exception found in the timely filing regulations at 42 section (b)(1), for "error or misrepresentation" of an employee, edicare contractor, or agent of the Department that was performing edicare functions and acting within the scope of its authority. f adds additional exceptions or modifies the existing exception to the timely filing regulations, specific instructions will be issued at a later date explaining those changes.

8 . BUNE EQUEENT TBLE hall" denotes a mandatory requirement Number equirement esponsibility (place an X in each applicable column) ontractors shall continue to subject claims with dates of service prior to October 1, 2009 to all relevant timely filing edits put in place prior to the effective date of this ontractors shall adjust all relevant claims processing system edits to ensure that 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 statute ontractors shall adjust all relevant claims processing system edits to ensure that claims with dates of service January 1, 2010 and beyond received more than 1 calendar year from the claim s date of service will be denied as being past the timely filing statute ontractors shall use the following remittance advice and N messages when denying claims as specified in , , and : eason code 29 - The time limit for filing has expired. emark code N211 You may not appeal this decision. Group code O ontractual Obligation N essage 25.3 The time limit for filing your claim has expired therefore, appeal rights are not applicable for this claim. / B D E E H H hared-ystem aintainers V X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X W OTHE El limite de tiempo para someter su reclamación ha expirado; por lo tanto, los derechos de apelación no se aplican a esta reclamación ontractors shall continue to determine whether a claim has been filed timely (within 1 calendar year from the date of service) according to the instructions contained in the edicare laims Processing anual, Publication , hapter 1, 70. X X X X X X X X X

9 . POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTH E B E aintainers provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. E H H X X X X X V W V. UPPOTNG NOTON ection : "hould" denotes a recommendation. X-ef ecommendations or other supporting information: equirement Number ec of the Patient Protection and ffordable are ct of 2010 ection B: N/ V. ONTT Pre-mplementation ontact(s): ontact David Walczak by at David.Walczak@cms.hhs.gov. Post-mplementation ontact(s): ontact the appropriate egional Office.

10 V. UNDNG ection : No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.