Claims Denied For Timely Filing

Claims for services provided should be transmitted no later than 24 hours after the visit date.  Medicare and commercial plans have strict filing time guidelines and will deny your claims if they are not received within the specified date.   Your insurance grid should be examined quarterly for the timely filing guidelines for each plan and updated should you become a participating provider for a new insurer.

The first step in avoiding timely filing denials is to do proper verification for any new patient or for an existing patient that has not been seen in your office within the past 3 months.   If your demographic information is not correct, you could be transmitting the secondary as the primary or vice versa.  By the time you receive the denial of claim and re-transmit to the correct plan, it may be too late.  This is why the Welcome Sheet is an invaluable part of your practice.

Another big problem are those claims that are secondary to Medicare.  The best way to avoid this problem is to work with your Medicare Explanation of Benefits as soon as it is received.  Your billing team must examine these benefit explanations and if the claims do not list "auto-crossover", you must copy the Medicare EOB and send it to the secondary within the time frame for filing.   I always include a printed HCFA for these secondary claims, so that the patient information is clearly labeled.  In those cases where a patient has more than one insurance secondary to Medicare, you should accomplish this task as soon as the Primary insurance payment is posted.

Many EMR systems have the ability to recognize the claims that are not subject to "Auto Crossover" and will automatically print a copy of the EOB as soon as the primary payment is posted.  Be mindful of the fact that many plans that originate through labor unions or locals may require that they receive a paper copy of the EOB, even if auto-crossover exists.   It may be a good idea to include a note on your insurance grid to remind you to send a paper claim for secondary payment.  The HCFA will show the amount paid and the amount pending for secondary payment.

If your practice is not EMR complete, the best way to insure timely filing is to make sure that your daily billing package is organized and complete.  The Welcome should be attached to the daily routing sheet or encounter, along with the referral for service, pre-certifications if applicable,  a copy of the sign in sheet, the daily data sheet showing all co-payments received, a copy of the deposit slip with the co-payment total and a copy of each patient check.  For new patients or those with insurance changes, I would also include a copy of the patient's insurance card.

The billing department then has an organized package that they can check off patient by patient, making their task basically a daily data entry and transmission.   Incomplete packages, such as those missing referrals or pre-certs or questions concerning demographic data can cause those claims to be put on hold and sometimes not entered in time to meet the timely filing requirements.

A Sample of Your Daily Data Sheet should include the following information and can be shown as a grid containing:

Todays Date
Patient Name
Doctor Seen
Insurance
Office Visit or Testing
Co- Payment Received
Comments

Filling in this data will assure that the daily package is complete.

Physicians must assist their staff in order to assure timely filing requirements by making sure that all of their billing sheets are completed and turned in or computed at the end of office hours each day.  The number of encounters should match the number of patients listed on the daily data sheet, unless otherwise noted.

Ideally, the physician should complete the encounter immediately after patient exit and turn it in to the front desk if you have a paper system or complete it electronically if your EMR is complete.  Once the billing sheet is turned over to the front desk, the patient check in sheet can be either highlighted in yellow or checked off in an electronic system.

Many EMR systems will track patients from the time they check in, note the times spent waiting and in the exam room, and notify the front office when the billing sheet is complete.  If you have an EMR system in your practice, the auto check in can serve as your data sheet.  Scan features will enable the billing team to view patient registrations, insurance cards, referral and authorizations.  Just make sure that whatever you scan into your system is readable and clear.

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