by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
August 26th, 2014
Be sure you have office procedures in place to keep an eye on the time frame of your claims: Claims denied by Medicare for “untimely submission” are not eligible for appeal. In fact most carriers do not afford you an appeal if timely filing is an issue; there are only a few exceptions. Timely Filing can have a significant impact on your Revenue.
Insurance companies are shortening the time-line for timely filing, and why wouldn’t they? It is more money in their pockets and less in yours. Some payers have a claims filing time-line as short as 30-90 days, some as long as two years. Just to motivate you a little more the Healthcare Reform is working on shortening this time-line as well. To read more about it (Click Here)
Pre-Claims Submission and Ways to Avoid Timely Filing Denials
- Verify the patients benefits and keep track of start dates and termination dates!
- Many times a claim will get sent in with incorrect information. This is why it is so important for the front desk to verify the patient’s demographics every time they arrive for an office visit. This is the most common reason for denial, however, it is also one of the few reasons you may appeal. If a staff member performing Medicare administrative functions submits a clerical error, such as a typo or perhaps the patient gives your office the wrong information or insurance card, you may have appeal rights.
- Enrollment date of Medicare Beneficiary (Retroactive Entitlement) is another common reason for denial. In this case, the Medicare timely filing deadline will be extended to the last day of the sixth month after the notice of entitlement was received.
- If a claim is stamped received after the filing time by the payer it will still be denied as Timely Filing.
- Do not procrastinate; any time a claim is sitting there it is money that is not in your bank. Ensure there are office procedures in place to avoid claims waiting for completion in one of the processes, such as signatures, documentation or coding.
- Reconcile your claims on a daily basis so you are not missing claims. (One way to reconcile is to verify them against your schedule). I like to process every visit in the day in a completed batch, if I am missing claims the batch is pending and therefore you go in search for the missing charges, the goal is to get the charges out on a consistent basis. Depending on the volume of your claims and your work flow, this may be daily or twice a week.
- Watch your provider payer reports on a daily basis, there are a lot of problems that occur on the claim level that can be caught earlier on in the process and therefore corrected prior to the next batch of claims sent out.
- Run reports from your Practice Management system to ensure claims are sent and being tracked.
- Be aware of your payer’s time-lines not just with claims but what are the timely filing period for corrected claims and appeals.
- Verify claim Status with the payer if not paid within the expected time frame of the payer. Contact them either on the phone, IVR or on-line, keeping up on your AR will help reduce these denials as well.
If you do run into an incorrect timely filing issue there are some steps you can follow to secure payment (if it was denied in error)
- Check Your Practice Management system to verify the submission date.
- Contact your clearing house for acceptance reports, you can use these to contact Medicare or the Payer that denied your claims. Your reports should show a “Payer Claim Control Number” this is the identification used to track electronic claims.
- Once the time line has been established you may be able to re-open the claim or submit a request for re-consideration for timely filing. Attach supporting documentation (PROOF OF FILING) such as the EDI acceptance report for electronic claim(s), attach a cover letter, to the appropriate address (usually on the back of the members card). Be sure to put the denied claim number on the claim so it is not rejected as a duplicate. If you can fax it directly to a claims representative, you will have a contact name to follow up with in 5-7 days as per their disclaimer.
CMS Exceptions to the timely filing requirement include the following: Read more (Click Here)
- Administrative error, if failure to meet the filing deadline was caused by error or misrepresentation of an employee, MAC, or agent of the U.S. Department of Health and Human Services that was performing Medicare functions and acting within the scope of its authority
- Retroactive Medicare entitlement
- Retroactive Medicare entitlement involving State Medicaid Agencies and dually-eligible beneficiaries; and Retroactive dis-enrollment from a Medicare Advantage Plan or Program of All-Inclusive Care for the Elderly provider organization.
Keep in mind; generally if a claim was denied for timely filing the patient is not responsible for payment, this liability falls back on the provider. It pays to be aware of your contractual agreements with your payers.