Health Center Regulatory Issues, Uncategorized

CMS Holding of Institutional Provider 2012 Date-of-Service Claims

By: Susan Sumrell

Happy New Year!  We wanted to be sure you saw this important message from CMS about 2011 Date of Service claims.  If you have any questions, please feel free to contact NACHC’s Director of Community Health Center Finance and Operations, Gervean Williams.

As the Centers for Medicare & Medicaid Services (CMS) implements calendar year 2012 changes, Medicare claims administration contractors will be holding some institutional provider claims containing 2012 services for up to the first 10 business days of January 2012 (i.e., Sunday, January 1, 2012, through Tuesday, January 17, 2012). Claims will be released as system testing is successfully completed, which we expect during that time frame.

The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. However, if you follow the status of your claim during the claims processing cycle, the claim status may not reflect what you would normally see because of the claims hold.

Medicare claims for services rendered on or before Saturday, December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames. We appreciate your patience as we implement calendar year 2012 changes.