Timely Filing Deadline Denials: Babysitting the Clock

Ever feel like you’re constantly putting out fires when it comes to claim denials? As a claims denial manager, you know the frustration of seeing rejections pile up, often for a seemingly simple reason: missed filing deadlines. This can be especially confusing for board members who see money being written off due to these missed deadlines.

But where exactly are these deadlines slipping through the cracks? Let’s break down the steps a claim takes before it reaches your desk. Understanding this can help identify areas for improvement.

 

The Claim Journey: Before It Gets to Coding

Think of a claim as a package that needs to be delivered on time. If there are issues at any point in the process, it can hold things up and miss the deadline. Here are some common roadblocks that can happen before the claim even reaches the coder:

• Patient Information Hurdles: It all starts with the patient. If they can’t provide complete and accurate insurance information upfront, delays can snowball. Missing member IDs, incorrect policy numbers, or even expired insurance all mean extra time spent chasing down the right details. This can be further complicated by patients who don’t respond promptly to requests for correct information, especially if they only decide to call after receiving a past due notice.
• Authorization Delays: Some procedures require approval from the insurance company before they are covered. If this process takes longer than expected, or the initial request is denied and needs more information, the clock keeps ticking towards the deadline.
• Coding Errors: Even with perfect information from the front desk, mistakes can happen during coding. If a claim needs clarification or correction from the coder, it can easily miss the filing window while waiting to be fixed.
• Clinician Charting Delays: Unfortunately, some clinicians struggle to complete their chart notes in a timely manner. Incomplete charts hold up the coding process and can cause delays that lead to missed deadlines.

Standard Filing Deadlines for Major Payers:

It’s important to remember that deadlines can vary depending on the specific plan and state. However, here’s a general guideline for some of the major payers:

• Medicare: Generally 12 months from the date of service.
• Medicaid: Varies by state, but typically falls within a range of 90 days to one year from the date of service.
• Medicare Advantage Plans: These plans are offered by private companies approved by Medicare and follow their own filing deadlines, which can range from 90 days to one year from the date of service. Be sure to consult the specific plan guidelines.
• Commercial Plans: Commercial plans offered by private insurance companies also have their own filing deadlines, which typically fall within a range of 90 days to one year from the date of service. Again, consult the specific plan guidelines for accurate information.

Keeping Claims on Track: Solutions to Streamline Submission

So, how do we prevent these deadline denials in the first place? Here are some practical steps to consider:

• Technology for Accuracy: Invest in electronic health records (EHR) systems with insurance verification tools. This can help ensure accurate information is captured upfront from the patient.
• Proactive Authorizations: Develop a system for identifying procedures requiring authorization and initiate the request well before the service date.
• Double-Check Before Sending: Implement a thorough review process to catch any coding errors before the claim goes out the door.
• Clear Communication is Key: Open communication channels between the front desk, authorization specialists, coders, and even patients can help identify and address roadblocks before they delay the claim.
• Diligent Refiling and Appeals: Timely re-filing of denied claims and pursuing strong appeals are crucial steps. However, these efforts can only go so far if the initial claim submission is delayed. The RCM team needs to be on top of unadjudicated claims to ensure they have the opportunity to get them out the door within the filing window, especially if the payer thinks they already received the claim.

 

By focusing on these solutions and creating a cyclical system that flags unfiled or un(re)filed claims 30 days prior to the deadline is crucial.  Understandably, easier said than done.  Identify the bottlenecks by pattern recognition.  Is it a certain location with a weak or high turnover of frontline workers or is it a certain provider that needs charting solutions of his/her own?  An analytical approach to identifying claims that repeatedly miss deadlines is key to not having to explain timely filing write-offs.