Anesthesia Billing: Referring Provider Edits Delayed
Anesthesia and Pain practices can breath a sigh of relief. The referring provider claims edits scheduled to go into effect on January 1, 2011 have been delayed until July 5th.
Anesthesiologists and CRNAs who order or refer services for Medicare beneficiaries must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and must be of a type/specialty that is eligible to order/refer services for Medicare beneficiaries. The new implementation date for Phase 2 is being delayed and will not begin on January 3, 2011. A placeholder date of July 5, 2011 has been stated in the revised CR 6417.
CMS Delivers Additional Information Regarding Medicare Timely Filing Rule
In the MLN Matters dated July 30, 2010, Change Request (CR) 7080, CMS gives additional instructions on the timely filing rule:
- For professional claims (CMS-1500 Form and 837P) submitted by physicians and other suppliers that include span dates of service, the line item“From” date will be used to determine the date of service and filing timeliness. (This includes supplies and rental items). For physicians and other suppliers that bill claims with span dates, these span date services cannot exceed one month.
- For institutional claims that include span dates of service (i.e., a “From” and “Through” date span on the claim), the “Through” date on the claim will be used to determine the date of service for claims filing timeliness.
- BE AWARE: If a line item “From” date is not timely, but the “To” date is timely, Medicare contractors will split the line item and deny untimely services as not timely filed.
- Claims having a date of service of February 29th must be filed by February 28th of the following year to be considered as timely filed. If the date of service is February 29th of any year and is received on or after March 1st of the following year, the claim will be denied as having failed to meet the timely filing requirement.
Change request (CR) 6960 specified the basic timely filing standards established for FFS reimbursement, which are a result of Section 6404 of the Patient Protection and Affordable Care Act of 2010 (ACA) that states that 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 Medicare.
