Here at Amvik Solutions, we have a thorough understanding of the processes involved with medical billing and claims submissions. We know how difficult it can be to ensure that all of your insurance claims are filed in a timely manner, or how a late filing can lead to a denial – and worse – diminished cash flow.
That’s why it is vital that your billing department has a clear understanding and system in place for timely filing. Because following up on unpaid or denied claims is such a time (and resource) consuming process, Amvik Solutions would like to provide you with a few essential tips to improve your workflow for timely filing, which will help to improve your clinic’s financial outlook.
Basics of Timely Filing
Insurance companies place time limits on claims submissions and timely filing refers to meeting this deadline. As a new clinic, or new credentialed provider to an insurance company, it is not only your responsibility to submit claims promptly – but perhaps more importantly – to know what these time limits are.
It’s important to recognize that every insurance company you work with has their own time window during which you can submit your claim. So if company “X” has a 60-day window after the date of ABA therapy service, then you have 60-days to effectively submit. Failing to meet this specified timely filing limit usually means a denial.
A few major insurance company filing deadlines include:
|Payer||Timely Filing Deadline|
|Medicare||12 Months (1 full calendar year) from date of service|
|Medicaid||95 days from date of service|
|Blue Cross Blue Shield||12 months from date of service (varies by state)|
|United Healthcare||Depends on contractual arrangements|
|Cigna||90 days in-network claim/ 180 days out-of-network claim|
|Humana||90 days from date of service|
|Aetna||180 day filing standard (varies by state)|
|Tricare||1 year from date of service (United States)|
These are only a few examples, but your billing department should be responsible for researching the timely filing deadline for each insurance agency you work with.
Alongside having the timely filing deadlines to each insurance company you work with printed out and placed in a clearly visible location that your billing department can refer to, you can also create a “cheat sheet” to help remind them of claim submission requirements for the various companies.
Valuable information to include on this cheat sheet, which may need to be created of each individual insurer, includes:
- Prior Authorization/Referral Info: The cheat sheet should note what prior authorization and/or referrals are required for the various therapy procedures and services your ABA clinic provides (per insurance payer). The process and information needed to obtain an authorization/referral should be included.
- Frequency of Services Allowed: Cheat sheet should include the permissible amount of services allowed by payer (i.e. frequency of ABA evaluations).
- Claim Submission Details: Note the type of manner by which the claim should be submitted. While most companies have transitioned to electronic claims submissions, a paper claim may still be required.
- Payment Due Dates: Just as you are required to submit a claim within a determined timeline, the insurer must submit payment to you within a required timeframe. Note what this is so you can make the necessary follow ups if the date passes.
Additional Tips for Timely Filing
Alongside understanding the various timely filing deadlines established by each insurer and developing a cheat sheet that can be effectively utilized by your billing department team, there are some additional strategies that can help improve your timely filing methods including:
- Billers must have a solid grasp of billing regulations and modifiers. An ineffectively trained billing team that is not familiar with CPT modifiers and doesn’t have the right system in place is going to cause hold ups in the billing process, which can result in delayed payments or decreased reimbursements.
- Have a great communication system with insurers. Inevitably, your bill department is going to have to deal with appeals and claims resubmissions. Having a solid communication line between your clinic and the insurer will help ease the processes and improve cash flow.
- Maintain adequate proof of timely filing. It is essential that you always keep records of your claims. With an adequate practice management system and software, you should be able to keep electronic claims with effectives dates saved on your computer and regularly back-up. You will need to maintain proof of timely filing for denials and appeals that arise.
On occasion, even with an optimal billing system and standards set in place, insurers will attempt to deny or underpay a claim. In the event of a denial and need for an appeal, Amvik Solutions can support you with the process.
Amvik Solutions offers medical billing services that covers every step of the process from beginning to end, helping to increase your monthly cash flow, so that you can do what you do best – providing quality ABA therapy.
Our billing team can provide a number of amazing benefits to your ABA therapy clinic or organization including:
- Electronic claim submissions whenever possible or paper claim submission as required.
- Unpaid and denied claims follow up with insurance companies and funding sources.
- Patient responsibility invoicing and follow up.
- Claims follow up through collection agency
- Client eligibility and benefit verification
- Regional Center co-pay/co-insurance coordination
- Comprehensive reporting – account ledger and claims denial report including an action trail documenting follow up correspondence with insurance companies and funding sources
Contact Amvik Solutions today at (805) 277-3392 to find out about more about the one-stop source for all your billing requirements.