What is payment floor?

The Medicare statute provides for claim payment floors. A payment floor is the minimum amount of time a claim must be held before payment can be made. Electronic claims are held 13 days and paper claims are held 29 days.

Federal legislation mandates that these payment floor time periods be based on “clean” claims. “Clean” claims are those that are completed correctly and contain all information necessary to issue a payment decision and Medicare Remittance Advice or Medicare Summary Notice. A “clean” claim is a claim that on a pre-payment basis does not require the Medicare contractor to investigate or ask the physician, supplier, beneficiary, or third party for further information. Claims not considered “clean,” and claims involving unique circumstances may be subject to longer processing periods while Medicare researches for more
information.

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