How to protect your claims from pesky timely filing denials

Timely filing is when you file your claim initially to your primary, secondary or tertiary payer for the first time. The tricky part is all that goes into this process. While you and the staff are treating patients, closing notes, handling scheduling and referrals, pre-authorizations, amongst 1000 other tasks you are also responsible to be extremely well versed in the payer requirements of their “timely filing” rules.

Below we have given a few tips to assist you in preventing these potential denials

1. Be sure Providers are aware of these payer rules. Pull reports of unsigned charts weekly to assure that charts are being signed and charges are going out far before your deadline.
2. Have standards in place for payers with short timely periods (60, 90, 180). Check this A/R early and often. Watch for front end edits and denials and be sure they are worked immediately. You may need to submit a specific form or provide proof with your appeal. Check payer requirements.
3. DON’T forget your secondary and tertiary claims. These may have their own set of rules based on that payer. Don’t let this revenue slip out of your hands.
4. If a claim gets denied for timely filing review all steps of the billing cycle to be sure the denial was not a mistake. Payers love to deny for this reason praying we, as billers, wont catch it!

What happens if we make a mere mistake? No one is perfect!!

Unfortunately, you will almost certainly see a denial. I do recommend to file the claim to show that the patient was seen and you have the record in your system. According to most contracts between providers and payers you will see a clause that the payer isn’t responsible for this claim and that you may not bill your patient. Of course, I would recommend you review your contract to be sure.

Review this denial with all the key players of your care team (providers, front desk, referral department, billing team, A/R team, IT/EHR specialist etc), find where the breakdown occurred. Use this example as a teaching tool to avoid future denials.

“If you’re early, you’re on time. If you’re on time, you’re late.”

Stay safe,

Stephanie

Are you unsure your billing practices are 100% accurate and you are getting paid for every claim? We offer FREE mini billing audits. Reach out today contactus@elitecodingandbilling.com