Medicare Timely Filing Limits And How To Avoid Missing Them

The Medicare Rule

Original Medicare claims must be filed within 12 months (one calendar year) after the date of service. For services spanning several dates, the limit runs from the through date on the claim. Claims received after the deadline are denied and the denial cannot be appealed.

Narrow Exceptions

• An administrative error by Medicare or its contractor caused the late filing
• The patient was retroactively entitled to Medicare
• The patient was retroactively disenrolled from a Medicare Advantage plan

Other Payers Are Shorter

Medicare Advantage plans set filing limits in their provider contracts. Commercial plans often allow 90 to 180 days, and state Medicaid programs set their own limits. Secondary claims usually have a separate deadline that runs from the primary payer's remittance. Every payer contract should be checked and its limit loaded into the billing system.

How Claims Age Out

• Charges never entered because a superbill or hospital encounter was missed
• Claims rejected at the clearinghouse and never corrected
• Claims sent to the wrong payer after an insurance change
• Denials left unworked until the corrected claim deadline passed

Prevention

Reconcile scheduled and hospital encounters against charges entered every week, work clearinghouse rejections daily, verify eligibility before each visit, and review aging reports by payer and filing deadline rather than by age alone.