Payment ceilings were
implemented for clean claims received by the carrier or FI on or after April 1,
1987. “Clean” claims must be paid or denied within the applicable number of
days from their receipt date as follows:
Time Period for Claims Received Applicable Number of Calendar Days
01-01-93 through 09-30-93 24 for EMC and
27 for paper claims
10-01-93 and later 30
All claims (i.e., paid claims, partial and complete denials, no payment bills)
including PIP and EMC claims are subject to the above requirements.
Interest must be paid on claims that are not paid within the ceiling period.
The count starts on the day after the receipt date and it ends on the date
payment is made. For example, for clean claims received October 1, 1993, and
later, if this span is 30 days or less, the requirement is met.
The RAPs submitted by home health agencies under the HH PPS (records with type
of bill 322 or 332 and dates of service on or after October 1, 2000) are not
Medicare claims as defined under the Social Security Act. Since they are not
considered claims, they (records with type of bill 322 or 332 and dates of
service on or after October 1, 2000) are not subjected to payment ceiling
standards and interest payment.
See Chapter 24, § 30.2 for definitions of electronic and paper claims for use
in application of the Medicare payment floor. See Chapter 1, § 80.2.1.2 for
differentiation between electronic claims that comply with the requirements of
the standard implementation guides adopted for national use under HIPAA and
those submitted electronically using pre-HIPAA formats supported by Medicare.
This HIPAA format differentiation applies to the payment floor, but not to the
ceiling
Reading this valuable content remain the history of Medical billing claims, I gave my Medical billing Services to some to leading medical billing company ACP in Chino. I want to know there were follow HIPAA regulation ?
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