Medicare program; claims payment cycle--HCFA. General notice

Area of Science:

• Health Policy
• Healthcare Administration
• Medicare Regulations

Background:

• Medicare claims processing is managed by intermediaries and carriers on behalf of the Health Care Financing Administration (HFCA).
• A payment floor requirement mandates a minimum retention period for processing Medicare claims.
• Section 4031 of the Omnibus Budget Reconciliation Act of 1987 established a 14-day retention period.

Purpose of the Study:

• To announce the retention of the Medicare payment floor requirement.
• To inform stakeholders about the 15-day payment delay for Medicare claims.
• To announce a temporary waiver for specific claim submission dates.

Main Methods:

• This is a notice regarding policy retention and waiver.
• No experimental methods were employed; it is an administrative announcement.
• Referencing existing legislation (Pub. L. 100-203) that mandated the original requirement.

Main Results:

• The payment floor requirement is being retained, delaying Medicare claim payments until the 15th day after receipt.
• This policy affects claims paid by intermediaries and carriers for services to Medicare beneficiaries.
• A temporary waiver of the payment floor is announced for claims submitted before October 1, 1990.

Conclusions:

• The 15-day payment floor for Medicare claims is maintained.
• Healthcare providers and beneficiaries should be aware of the payment processing timelines.
• The temporary waiver provides a specific window for previously submitted claims.