RESULTS OF UNTIMELY CLAIM SUBMISSION

In healthcare insurance, timely filing of claims is important. If the service provider misses the deadlines, or limits set by medical billing companies then the service provider may lose some revenue from services.

What is meant by timely filing?

Every medical service provider is familiar with the timely filing of claims. To get the payments, medical billers need to submit their patient’s claim within the time limit set by insurance providers.

Taking an example, a patient takes services at the doctor’s office on March 19, and they are covered by the medical insurance of company XYZ. If company XYZ has set their limit of submitting the claims to 90 days, after taking the service, the doctor’s office needs to submit the patient’s claims within 90 days after the patient’s visit.

Getting the payment for the provided healthcare services is straightforward. It means providing the service, submitting the claims, and getting the payment. This process looks simple, but there could be too much working with this process.

One of the common reasons for denial of claims is the late filing of claims or missing the filing of claims. Each payer has its own set of time frames during which the service provider needs to submit the claims for getting the reimbursement for their services. This filing deadline time limit may range from 90 days to 12 months from the date of service.

Failing to file the claims within the required time limit may result in a serious loss of revenue for your practice, which means writing off the charges. It also means that patients can not be billed for the services if the payer missed the deadline.

There could be many possible reasons for missing the time limit of filing the claims like charge tickets or superbills are not prepared completely resulting in loss of practice revenue cycle. Healthcare practice can prevent such types of denials by checking on the practice management system to generate a missing ticket that will easily identify the services for which no corresponding claims have been entered into a database. With these reports, any medical practice can easily identify the claims that are missing the charge entry. When such superbills are identified, the medical coder can do the needful allowing the filing of claims promptly.

For maintaining a smooth revenue cycle, healthcare practice must identify the unbilled claims and file them as soon as possible. Sometimes the corrected claims may be denied for exceeding the filling periods. Such types of errors can be checked by the provider clearinghouses. If the corrected claim is not submitted rightly, then the claim may be denied for exceeding the number of filing limitations.

Final words:

The claim filing process on time is supposed to be very important. Therefore, following some steps like entering the correct demographic information of the patient, checking the eligibility of the patient, checking the pre-authorization requirements, keeping the practice updated with new regulations, and finally submitting the claim within a time limit can help in the growth of the practice.