Reminder: Denied Medicare claims require response within 45 days

Health care practitioners who have claims denied or otherwise returned for additional information must respond within 45 days or those clams will be rejected, the AOA Advocacy Group reminds practitioners.  

 "... the Centers for Medicare & Medicaid Services' standard is that any (problem claim) that has not received a response within 45 days of that development will result in the claim(s) being rejected due to lack of information," National Government Services (NGS), the Medicare carrier for New England, noted in a recent reminder to practitioners in its service area.

Medicare instructs carriers to deny payment for any claims on which any required information has been omitted and return such claims to the submitting practitioners. The practitioners then have an opportunity to resubmit the claims with all required information in place.

Many practitioners and billing staff may not be mindful of the difference between a "denied" claim, which can be resubmitted for payment with any requested additional information, and a "rejected" claim, on which the Medicare carrier has made a final determination not to issue payment, the AOA Advocacy group notes.

Moreover, they may not be mindful that they can resubmit denied claims for only 45 day, the AOA Advocacy Group adds.

NGS issued the reminder to practitioners after noting a slight increase in returned claims for which responses are not received.