Tick Tock, Pay Attention to the Clock, or Timely Filing May be Locked!

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One of the changes over the last quarter-century in the billing and revenue cycle process has been the introduction of timely filing limits.  Essentially, timely filing limits are specific timelines that a claim for services rendered must be received by the insurance company.  These limits are imposed timelines by government payors, commercial payors, and even state mandates.  While it seems easy enough to meet a preset timeline, there can be many challenges and hiccups along the way.  Unfortunately, all too often, you as the provider of service, do not even know it is happening.  How can you ensure you are not losing money from a lack of timely filing?

Step 1

Know your contractual obligations for each insurance company.  Review your contracts and amendments on a routine basis for timely filing requirements as well as each time your agreement is renegotiated or updated.  If you have less than six months from the date of service to submit, be sure to include this section the next time there is an opportunity to renegotiate the contract.  The extended time of six months will allow for unexpected delays in the filing process including delayed addendums, electronic data file challenges, or other unanticipated circumstances such as a patient providing updated insurance information.  All follow up needs to be completed within the timely filing limits.  Any portion that is not, may cause you to lose revenue.

Tip: Do not forget about provider enrollment.  This will impact your timely filing too.  Watch for our next blog dedicated to this topic.

Step 2

Evaluate the regulations and guidance in the states where you provide services for any timely filing requirements to insurance companies.  Over the years, various states have adopted legislation that requires providers to submit claims within a specific timeframe.  That timeline may differ from your insurance contracts.  Depending on how the law is written and what is stated in your contract, one or the other may take priority.  You should know both to ensure you do not miss out on any revenue.

Tip: Along with timely filing limits, many states have prompt payment laws.  Be sure to know these for when the insurance is taking too long to pay a clean claim, you will have the law easily accessible to aid in a speedy resolution often with interest.

Step 3

You know the old saying, ‘what goes up must come down’ right?  Well with billing it is a bit different, ‘with all claims submissions also come denials.’  Regardless of how many times the patient demographics are reviewed, scrubbed for errors and eligibility checked, there will always be denials.  Ideally, a much smaller amount after prebill steps are taken.  Unfortunately, denials are subject to time limits as well.  Once a claim is denied, the clock does not necessarily start over.  It may start with a different calendar.  Here is another area where you need to know your insurance contracts.  Some will give you only 60 days from the date of denial, while others may give you 120 days.  Appeal time limits can be renegotiated to provide more time as well.  It is vital you know the actual date of denial, not the date it was processed in the billing department.  Use the date of denial along with your new list of when appeals are due to ensure you submit your request to overturn the denial before your time runs out.

Tip:   Many clearinghouses will provide a proof of timely filing document for each claim to assist in appeals.  This will include details about when the electronic claim was filed and subsequently acknowledged by the payor.  Use this documentation to beef up your appeals and track your adherence to the time limits.

The best process is to know your state laws and to know your insurance contracts. The insurance company will not hesitate to deny your request for payment for timely filing.  When a biller inquires, the insurance will be quick to point out that you did not submit your initial claim or your appealed claim on time.  Be mindful of your time limits and processes.  The days from providing the service to the expiration of time limits will pass quickly.  Do not let them go by without noticing.  Do not give your services away for free because someone didn’t check your contracts or state laws!