Simplifying Timely Filing
Essential Strategy For Revenue Cycle Success
Timely filing is an integral part of the claim cycle that designates how quickly a biller must submit a claim to the payer. Although this concept can seem simple, any small error can wreak havoc on a practice’s revenue cycle. Even just one rejected claim can result in lost revenue.
What is Timely Filing?
Each insurance company provides a number of days, weeks, or months for a timely claim submission. If the claim is not received within the given time frame, it will be rejected and returned as a denial. Keep in mind that claims still take time to send and process, even though effective technology continues to make this process faster.
Example: Medicare claims must be filed no more than 12 months after a service was provided. If a biller fails to submit a claim promptly, or if a provider does not provide the biller information in time, Medicare will not honor the cost of the service on the late claim, and it will be returned as a denial.
Even though 12 months might seem like plenty of time to submit a claim, it becomes more complicated when you’re working with a large practice that sees hundreds of patients a day, or when an insurance company only gives you 90 days to file a claim. A single missed claim can result in a large amount of lost revenue.
If the timely filing criteria isn’t met, the provider will not be paid for the services that they provided. This causes a higher volume of work with a lower amount of incoming profit. It’s also important to remember that not every insurance company has the same filing limit, so you’ll have to keep track of multiple filing limits. Unfortunately for the provider, these factors are often out of their control, but an effective PM software can take the worry out of the timely filing process.
Why is Timely Filing Important?
It’s clear that timely filing is crucial to both a biller and provider. Ultimately, timely filing is a “make or break” aspect of the revenue cycle. Providers don’t want to lose any revenue from the work that they’re providing, and billers don’t want to do work that sacrifices time and money.
Note: The responsibility doesn’t fall to the patient if a biller fails to file a claim on time—it falls on the provider. If you’re a patient, you can take a deep breath, but billers and providers must be careful with these limits.
If you have a PM software that allows you to batch claims, you will be saving time and money that would otherwise be spent going through the tedious process of sending individual claims and potentially missing filing deadlines due to an improper workflow. By following the filing guidelines that each insurance company provides, you will decrease your chances of your claims being rejected and returned as a denial.
OpenPM Makes Timely Filing a Priority
Any effective PM Software should understand the importance of providing a timely filing workflow, but many systems still don’t prioritize this function. Open Practice understands that timely filing is one of the key components in the process that gets the provider paid. We’ve come up with some ways that help simplify this process, such as the ability to set a default number of days for timely filing for an insurance billing group. This gives a busy biller one less function to remember, and stops the provider from taking any time and energy away from their patients. Even the best biller in the world makes mistakes, so it’s important to choose a PMS that fits your needs. As we mentioned earlier, timely filing isn’t always as simple as it seems to be.
OpenPM understands how hard providers and billers work to care for us everyday. By building a system that supports the day-to-day functions of these workers, we care for the people that are always there for us.
Timely filing does not need to be the worst part of your day—you shouldn’t have to worry about this aspect of the claim cycle using a reputable PM software. Timely filing will always be important, so let’s work together to make it manageable.
