Timely Filing and Its Impact on Medical Coders and Billers

by  Find-A-Code™
Sep 14th, 2023

When people talk about medical coding and billing, they have a tendency to discuss things like CPT and ICD-10 codes. They talk about finding the right codes and making sure the right modifiers are used with them. Another topic worthy of discussion is something known as 'timely filing'. Timely filing has an enormous impact on coders, billers, and service providers.

Timely filing is best described as an established timeline for filing claims. Think of it as a deadline. Insurance companies and public payers (e.g., Medicare and Medicaid) have implemented filing deadlines to ensure that claims do not linger. They want to get claims submitted and paid as quickly as possible.

How It All Works

Payers are free to establish their own deadlines as they see fit. There is no official standard. However, those deadlines must be included in the contract language. Let us arbitrarily choose a deadline of 30 days for a mainstream insurance carrier. A private practice under contract would have only 30 days from the date of service to file an accurate claim with that carrier.

What happens if the deadline is missed? The insurance company could deny the claim and the practice would not be paid for services rendered. It is a scenario that no medical provider wants to be in.

To avoid missing timely filing deadlines, medical providers establish policies and procedures intended to move claims along. Said policies and procedures apply whether a provider handles coding and billing in-house or outsources to a contractor.

It Starts at the Clinical Level

The interesting thing about timely filing is that it isn't the responsibility of just one individual. It actually starts at the clinical level, where patients receive services. Whoever takes that first set of notes detailing services starts the ball rolling. In many cases, it is a doctor or advanced practice nurse.

After the fact, the notes taken in the clinical setting go to the medical coder. It is the coder's responsibility to decipher the notes and translate all the rendered services and procedures into the appropriate CPT, ICD-10, etc. codes. From there, the data gets transferred to a billing specialist.

Medical billers review the work done by coders for accuracy. That work is then translated into claims that will ultimately be transmitted to payers. The payers are the last leg of the billing journey. They have dedicated staff who verify each claim and then either approve it for payment or send it back with a denial.

Denials and Timely Filing

A big concern with timely filing has to do with denials. Again, each payer is free to set their own timely filing policies. You might have an insurance carrier whose deadline only applies to the initial claim. Extra time is given when claims are returned for adjustment. You might have another insurance company that requires claims to be fully approved prior to the deadline.

Understandably, timely filing deadlines can put a lot of pressure on medical coders and billers. That's why employers emphasize the ability to work quickly while still minimizing errors. They need coders and billers who can quickly transfer data into accurate bills that are submitted on time and paid promptly.

To be fair, a lot of jobs have deadlines attached to them. Medical billing and coding are not the only ones. It is just that the pressure coders and billers are under can be more pronounced than other types of occupations. It takes a special kind of individual to be able to tackle the complexities of medical coding and billing without cracking under the pressure of timely filing deadlines.