Summary
Effective for services furnished on or after January 1, 2010, clarifies the maximum period for submission of Medicare claims to be not more than 12 months.
Implementation Status
Prior to January 2013, in 2010, CMS released final regulations pursuant to this provision (see here and here). CMS also issued a transmittal regarding this change.
On Sept. 4, 2014, CMS issued 22 FAQs for states regarding Coordination of Benefits (COB) and Medicaid Third Party Liability (TPL). The FAQs address concerns about claim submissions (including requirements at sec. 6404 of the ACA), privacy when exchanging data between insurers and the state, and the use of outside contractors. Additionally, CMS has released a Guide to Effective State Practices that provides state Medicaid programs’ information about COB/TPL practices that states have implemented and found effective.
Statutory Text
SEC. 6404. MAXIMUM PERIOD FOR SUBMISSION OF MEDICARE CLAIMS REDUCED TO NOT MORE THAN 12 MONTHS. (a) REDUCING MAXIMUM PERIOD FOR SUBMISSION.— (1) PART A.—Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)(1)) is amended— (A) in paragraph (1), by striking ‘‘period of 3 calendar years’’ and all that follows through the semicolon and inserting ‘‘period ending 1 calendar year after the date of service;’’; and (B) by adding at the end the following new sentence: ‘‘In applying paragraph (1), the Secretary may specify exceptions to the 1 calendar year period specified in such paragraph.’’ (2) PART B.— (A) Section 1842(b)(3) of such Act (42 U.S.C. 1395u(b)(3)(B)) is amended— (i) in subparagraph (B), in the flush language following clause (ii), by striking ‘‘close of the calendar year following the year in which such service is furnished (deeming any service furnished in the last 3 months of any calendar year to have been furnished in the succeeding calendar year)’’ and inserting ‘‘period ending 1 calendar year after the date of service’’; and (ii) by adding at the end the following new sentence: ‘‘In applying subparagraph (B), the Secretary may specify exceptions to the 1 calendar year period specified in such subparagraph.’’ (B) Section 1835(a) of such Act (42 U.S.C. 1395n(a)) is amended— (i) in paragraph (1), by striking ‘‘period of 3 calendar years’’ and all that follows through the semicolon and inserting ‘‘period ending 1 calendar year after the date of service;’’; and (ii) by adding at the end the following new sentence: ‘‘In applying paragraph (1), the Secretary may specify exceptions to the 1 calendar year period specified in such paragraph.’’ (b) EFFECTIVE DATE.—(1) IN GENERAL.—The amendments made by subsection (a) shall apply to services furnished on or after January 1, 2010. (2) SERVICES FURNISHED BEFORE 2010.—In the case of services furnished before January 1, 2010, a bill or request for payment under section 1814(a)(1), 1842(b)(3)(B), or 1835(a) shall be filed not later that December 31, 2010.