- Introduction
- About Provider Outreach and Education
- ABN for Not Reasonable and Necessary Denials
- Appeals/Reopenings
- Assignment of Benefits
- Comprehensive Error Rate Testing
- CMS-1500 Claim Form
- Deceased Beneficiary Claims
- Electronic Data Interchange
- Evaluation and Management Services
- Fraud and Abuse
- Health Professional Shortage Area
- Hospice
- Limiting Charge
- Medical Policy Development
- Medigap
- Modifiers
- Nonphysician Practitioners
- National Provider Identifier
- Participation Program
- Payment Floor Standards
- Provider Enrollment
- Refunds and Overpayments
- Ordering and Referring Claims Information
- Return/Reject
- Standard Remittance ANSI Codes and Remittance Advice
- Appendix 1: Forms
- Appendix 2: Glossary
- Appendix 3: Place of Service Codes
Medicare Part B 101 Manual
Payment Floor Standards
The “payment floor” establishes a waiting period during which time the contractor may not pay, issue, mail or otherwise finalize the initial determination on a clean claim. The “payment floor date” is the earliest day after receipt of the clean claim that payment may be made.
The payment floor date is determined by counting the number of days since the day the claim was received, i.e., the count begins the day after the day of receipt.
The payment floor does not apply to: no-payment claims, RAPs submitted by HHAs, and claims for PIP payments.
There are different waiting periods, and thus different payment floor dates, for electronic claims and paper claims. For the purpose of implementing the payment floor, the following definitions apply:
- An “electronic claim” is a claim submitted via CPU to CPU transmission, tape, direct data entry, direct wire or personal computer upload or download. A claim that is submitted via digital fax/OCR, diskette or touch-tone telephone is not considered an electronic claim.
- A “paper claim” is submitted and received on paper, including fax printouts. This also includes a claim that the contractor receives on paper and then reads electronically with OCR technology.
Based on the waiting periods, the payment floor dates are as follows:
| Claim Receipt Date | Payment Floor Date |
|---|---|
| 1/1/2006 and later | 14th day for HIPAA-compliant EMC |
| 1/1/2006 and later | 29th day for paper |
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Reviewed 9/29/2023