One of our practices recently received a letter from one of their payers stating they are changing their filing limit to 90 days. Now if you own your own office and have ready access to your billing information this is no big deal, but if you are a hospital based provider or rely on others for demographic of payment information this is a big issue. For example there are many hospitals that cannot finalize a case until two weeks after the discharge date, add time for billing process and denials and it doesn’t seem hard to see how sometimes this filing limit is missed. Ideally this would never happen in a perfect billing world, but billing is far from perfect.
Now why is this happening? Well more and more it seems every contract that you sign is just a series of denial reasons to keep a claim from being paid. Often we are seeing denial rates from major payers over 20%! This means 20% of the claims have to be re-filed and reworked and this means more time and effort on your biller’s part. By the way, Medicare has only a 4% denial rate.
This means that your processes and efforts must be running at complete efficiency to keep the money flowing smoothly.
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