Certified Revenue Cycle Representative (CRCR) Practice Exam

What happens to claims with dates of service received later than one calendar year beyond the date of service?

1. Denied by Medicare

2. The provider's responsibility but can be deemed charity care

3. Fully paid with interest

4. The full responsibility of the patient

The correct answer is: Denied by Medicare

Claims with dates of service received later than one calendar year beyond the date of service are typically denied by Medicare. This is due to specific time limits set by Medicare regarding the submission of claims, which must typically be submitted within one year from the date of service. This policy helps ensure timely processing and payment for services provided while allowing for efficient management of resources and reducing the backlog of overdue claims. When claims are not submitted within this timeframe, they are considered stale, and Medicare does not accept them for payment. This ensures adherence to regulatory timelines and allows Medicare to allocate funds effectively. Other options may involve various interpretations of responsibility or outcomes, but Medicare's established policy strictly enforces the one-year submission limit leading to denials for late submissions.