Timely Filing – Submitting the claim is not enough

Working in the home infusion industry since 1987, I’ve seen a lot of things that were hard to believe.  One day I watched a billing clerk sit and write off claim after claim with absolutely no emotion.  I asked her why she was writing them off instead of billing them and she said, “because I can’t bill them.  I don’t have an authorization and the time limit to submit the claim has passed.”  Within 6 months this hospital based home infusion was closed and sold to a national home infusion company.

Years later we wrote a report for a very progressive company that had a zero tolerance for timely filing denials.  Their process was to validate that every claim was not only submitted, but also received prior to the filing deadline.  Most people think of timely filing as the number of days a provider has to submit the claim to get it paid.  I learned from this customer that when a claim has been submitted, but not verified as received, the claim was still at risk for a timely filing denial.  To meet a zero tolerance objective on timely filing denials, you must have a process in place to identify claims that have been sent but may not have been received and contact the insurance company or resubmit the claim.

The following is a proven process, utilizing Rock-Pond Reports to give you the information you need.

  1. Establish a zero-tolerance policy for timely filing denials.
  2. Run the Rock-Pond A/R adjustments for the last year by payer within adjustment reason and review all of the claims denied because the timely filing deadline had past.  This will tell you the extent of your problem.
  3. Identify the most common timely filing deadline for your insurance companies, most likely 90 or 120 days.
  4. Identify all insurance companies whose timely filing requirements are less than or greater than this number of days.  Load the timely filing deadline for these companies in your insurance tables.
  5. Using the Rock-Pond Unbilled Report for claims within our X days of timely filing, work the claims to make sure they are submitted, even if they will be denied for some reason.  You can resubmit a claim denied for lack of authorization but you can not submit a claim you didn’t file in time.
  6. Once claims are submitted, follow up to see that they are confirmed as received and record a billing note with the receipt validation.  This can be through an electronic claim response file or talking to someone on the phone.
  7. Using the Rock-Pond Claims in A/R that are within X days of timely filing, work these claims by calling to verify receipt or resubmit the claim.  The report will show all claims that are within the timely filing limit and have not had a payment, adjustment or note posted.
  8. Enforce your no-tolerance policy for timely filing denials.

One of the main problems with standard procedures used to manage timely filing collections is people typically assume if you sent out the bill you will not get a timely filing denial.  Adding the management of sent claims to your timely filing process will help you identify claims you think you have sent but have not been received and get you closer to your zero-timely filings.