CMS Pub. 100-04, ch. 1, § 70.8.6

Section 1848(g)(4) of the Social Security Act (the Act) requires that physicians and

suppliers complete and submit Part B claims for medical services, equipment and

supplies (furnished on or after September 1, 1990) within 12 months of the service date.

Only assigned claims submitted more than 12 months after the service date will be

subject to a 10 percent reduction of the amount that would otherwise have been paid.

Payment on an assigned claim submitted by a physician or other supplier 12 months or

longer after the service is furnished, shall be reduced by 10 percent from the amount that

would have otherwise been paid. On March 23, 2010, Congress passed the Patient

Protection and Affordable Care Act (the Affordable Care Act). Section 6404 of the

Affordable Care Act amended sections 1814(a)(1), 1835(a)(1), and 1842(b)(3)(B) of the

Act, by reducing the maximum time period for filing Medicare Part A and Part B claims

to no more than 12 months after the date of service. Therefore, this nullifies the 10

percent reduction requirement on physician and supplier claims submitted after 12

months from the date of service, because the claim will be denied as untimely filed;

unless, an exception for the late filing is granted. And, if an exception for late filing is

granted, then the 10 percent penalty is waived.