Teresa Posted Tue 07th of February, 2012 18:50:00 PM
Can anyone please advise if filing a clean claim that is not processed in a time frame set fourth either by the carrier, contract or based on the time limit for a prompt pay state if interest can be collected from the carrier?
SuperCoder Answered Wed 08th of February, 2012 20:05:28 PM
Page#214 of https://www.cms.gov/manuals/downloads/clm104c01.pdf
80.2.2 - Interest Payment on Clean Non-PIP Claims Not Paid Timely
(Rev. 1771, Issued: 07-17-09, Effective: 08-17-09, Implementation: 08-17-09)
Interest must be paid on clean claims if payment is not made within the applicable number of calendar days (i.e., 30 days) after the date of receipt as described above. The applicable number of days is also known as the payment ceiling. For example, a clean claim received on March 1, 2009, must have been paid before the end of business on March 31, 2009. Interest is not paid on:
• Claims requiring external investigation or development by the provider’s FI or carrier;
• Claims on which no payment is due;
• Full denials;
• Claims for which the provider is receiving PIP; or
• HH PPS RAPs
Interest is paid at the rate used for §3902(a) of title 3l, U.S. Code (relating to interest penalties for failure to make prompt payments). The interest rate is determined by the applicable rate on the day of payment.
This rate is determined by the Treasury Department on a 6-month basis, effective every January and July 1. Providers may access the Treasury Department Web page http://fms.treas.gov/prompt/rates.html for the correct rate. Medicare contractors shall include notification to providers of any change to the Treasury Department interest rate in their routine educational materials and/or website for providers.
Interest is calculated using the following formula:
Payment amount x rate x days divided by 365 (366 in a leap year) = interest payment
The interest period begins on the day after payment is due and ends on the day of payment.