News - Weekly RCM Tip: Stopping Untimely Denials

Although we all know with the right attention and tools we can prevent the majority of claim denials, it would be impossible to achieve a zero percent denial rate across all denial reasons. Payers are simply not transparent with all of their processing rules and claim edits, so they will always find ways to delay payment of claims. 

However, if a payer imposes filing limits, the terms are always very clear. Not only do the payers tell us how long we have to bill a claim, they also tell us when we have rights to appeal and how long we have to file those appeals. Pretty straight-forward. Then why do untimely filing denials account for a high percentage of dollars written-off as uncollectible each year?

There is nothing more discouraging than providing services to a patient and having to lose the reimbursement you deserve for failure to bill and resolve a claim in timely fashion. Here are some ideas to help reduce the risk of write-offs due to untimely filing:

• Improve your first pass denial rate for other reasons. Denials for eligibility, technical errors and other issues will eat into the time you have to get payment, so reducing those also reduces your chances of untimely filing.
  
  
• Monitor your unbilled claims – focus on those payers you have tight filing limits. You need to allow for time for payer response and follow up on a potential rejection, so you need to send initial bills within 50-60 days of the filing limit. Have queries that flag any claim being held for a payer with a filing limit.
  
  
• Make sure to work “at-risk” accounts in work queues or via ATB’s. Anything within 60-days of the payer’s filing limit should be considered at risk and receive prompt attention.
  
  
• Work denials and rejections daily – don’t let them age beyond the time to do appeals.
  
  
• Know your contract terms. Too often the business office staff isn’t provided with the actual contract terms so they base their write-off requests on payer rejections. Many payers will reject for filing limitations even when they have no contract with you.  If the A/R staff doesn’t have this information, you could be writing things off unnecessarily. 
  
  
• Find an automated way to retain the electronic acknowledgement data from the payer so that if you do get denied, you have proof of timely filing easily at hand.
  
  
• Don’t enter into contracts with payers for unreasonable timeframes. The shortest timeframe for a filing limit should be 90-days.  Any payer requesting filing limits should also have matching timeframes for when they can recoup payments if they processed incorrectly.
  
  
• Include provisions for COB issues in the contract. If patients failed to provide the accurate insurance information, providers should have recourse to waive the initial filing limit based on the time they were notified of the coverage.
  
  
• Watch your workers' compensation and liability cases. If the patient has Medicare, Medicaid, or Health insurance and the claim is not being processed timely by W/C or there is question of coverage, make sure to bill the health insurance before losing those dollars as well.