When Indiana Medicaid recently announced they were slashing their timely filing limit from 12 months to 180 days beginning in 2019, you may have thought, “No big deal. We meet filing limits as small as 90 days on a regular basis.” But as doable as the new limits are, the change does provide a good opportunity to discuss why everyone involved in the revenue cycle, from providers to follow-up team members, needs to be aware of filing limits and what they can do to help meet them.
What Are Timely Filing Limits?
First, a refresher. What are timely filing limits? They are simply deadlines for filing claims or appeals to an insurance provider. Generally, timely filing limits are marked from the date of service for claims (or date of discharge for inpatient claims) and date of claim determination for an appeal. Among a single payer, they can vary by contract, plan, or state, and among all the payers, they can vary in time (anywhere from 90 days to six years), by provider status (some payers have different deadlines for contracted and non-contracted providers), and by type, with different deadlines for filing claims, corrected claims, appeals, etc.
What Can I Do to Stay within Them?
Now, a few tips to help you stay within timely filing limits, starting with the front end of the revenue cycle and working our way back.
Take extra time to confirm demographic and insurance information. A wrong birthdate, subscriber name, or group number can prevent your claim from being processed correctly by a payer the first time. Incorrect or rejected claims don’t generally extend your filing deadline (unlike an incorrectly paid claim, where there’s often a new deadline to file an appeal), so encourage your staff to take the time upfront to get the details right.
Wrap up your documentation quickly. The filing limit for submitting claims almost always begins with the date of service, not the date you finish dictating or typing in your notes. So every day a physician puts off charting is another day gone for meeting the filing deadline.
Release your charges for billing as soon as possible, whether you use a billing company or an internal billing office. Any delays in getting the charges entered and out the door to payers could jeopardize a timely filing.
Respond quickly to questions or requests for more information. Sometimes, these requests come from the billing company or billing office, and every day they go unanswered the clock is ticking on the filing deadlines. But sometimes, payers need more information, and they deny or delay their determination of your claim until you send more information. While requests for information usually come with a separate deadline, not responding to the request on time could result in a permanently unpaid claim.
Reconcile your billed charges to a hospital roster or office log to be sure every charge has been entered. Do this as soon as possible after the date of service so you’ll have time to file any missed charges before the filing deadline.
Be sure your electronic claims clearinghouse offers proof that the claim was sent and received. Most payers don’t allow appeals of timely filing denials, unless the provider has proof that the claim was sent and received by the payer prior to the deadline. Be sure this information remains available for weeks or months after the claim has been submitted so you can use it to appeal a timely filing denial.
Follow-up on ignored, rejected, or denied claims, resubmitting claims the payer rejected or never received and providing quick responses to requests for more information. For claims denied because they were not received within the filing limit, submit an appeal with the proof of timely filing from your clearinghouse, if you have it. Also, most payers have different deadlines for appeals of incorrectly paid claims, but be sure to give yourself plenty of time to appeal any denials or underpayments before the new deadline.
Hold members of your team responsible for their role in expediting the claims processing. Log when charges are received in the billing department from the physician. Monitor how quickly the charges were entered by the billing team. Calculate the average time between date of service and date of entry by physician to determine if any members of the team are keeping charts open too long. Keep a log of unresponded to questions or requests for information by physician. In general, it’s a good idea to track claims denied for not meeting filing limits, and with a properly documented trail, you can go backward from there to determine where the hold up was.
We still have just over three months before the new 180-day filing limits go into effect for Indiana Medicaid, but in the meantime, brush up on all your timely filing limits, and determine what more you can do now to be sure you meet them.
Good news! We’ve done some research to create this nifty guide for you of some of the larger payers and their timely filing limits.
But as you’ll see, we left room for you to add your own customized dates, because the most accurate source of timely filing limits for your practice is in your provider contracts. Also, we left room at the bottom for you to add additional payers and plans because those can vary significantly by practice and locale.
Download your Timely Filing Limits Cheat Sheet now!
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