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Thread: Timely filing denial/patient repsonsibility

  1. #1

    Default Timely filing denial/patient repsonsibility

    AAPC: Back to School
    is the patient responsible for their 20% coinsurance for medicare claims filed after the limit for timely filing?

  2. #2


    I have to say no the patient is not responsible...per the Medicare EOB.

  3. #3


    well if the medicare eob said not members responsibility then I wouldnt bill the patient but I was just curious if anyone knew because I found a few unbilled services, and if there was a possibility of the coins still being billable then that is one thing, but if its just going to be a flat out denial then I won't waste my time.

    I had blue cross blue shield send me a timely filing denial and they made patient responsible for 100% of charges so it made me wonder.

  4. #4
    Join Date
    Apr 2007
    North Carolina


    Q16 What is the time limit for filing a claim? What are my options when I receive a CO-29 (the time limit for filing has expired) denial?

    A16 As a result of the Patient Protection and Affordable Care Act (PPACA), Section 6404, 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 for past timely filing. For example: if your claim has a date of service on March 21, 2010, the claim must be filed by March 20, 2011.

    Claims with dates of service prior to October 1, 2009, will be subject to pre-PPACA timely rules and edits (see the timely filing chart in the DME MAC Jurisdiction C Supplier Manual, Chapter 6).

    Claims with dates of service October 1, 2009 through December 31, 2009 must be received by December 31, 2010.

    For more information about timely filing related to PPACA, please refer to the MLN Matters Article MM6960 .

    If you have received a denial for past timely filing, you may bill the beneficiary for 20% of the allowed amount; however, you will not receive payment for the other 80%. If you feel you can show good cause for filing late, you may submit a request to reopenings.


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