How Missing Timely Filing Deadlines Impact Your Lab’s Success
After Change Healthcare’s data breach this year, the healthcare industry was struck by a simple issue where doctors can stand to lose millions of dollars: missed timely filing limitations. These deadlines may be easy to follow, but denials due to various errors can disrupt your workflow and hurt your bottom end. This is a wake-up call to all labs that your revenue cycle management matters. Learning about the impact of missed timely filing deadlines is a good start to ensure you are well-guarded for any setbacks in lab billing.
In this blog, let’s discuss timely filing, the barriers to staying on track with deadlines, and the best tips for RCM.
What is Timely Filing?
Timely filing refers to the established timeline for filing claims. Insurance companies and public payers (e.g., Medicare and Medicaid) aim to submit and pay claims as quickly as possible through timely filing.
This can be the amount of time a provider has to submit a claim to the insurance company to have it paid or the amount of time a provider has to submit an appeal on any denial received.
Please note that different insurance companies may have their own timely filing limit, such as a 90-day timely filing limit. That’s why, on top of your lab staff’s duties to take tests, deliver services, and tend to patients, they also need to know the timely filing limit for the insurance company to which you are submitting claims.
Barriers in Timely Filing for Lab Services
Unfortunately, labs struggling with timely filing has to do with various factors, such as:
- Lab billing denials: With 10.8% of claims denied upon initial submission, many laboratories need to resubmit claims, affecting their timely filing deadlines. Denials are commonly caused by inaccuracies in patient demographics, eligibility and coverage issues, incorrect or incomplete coding, and missing required documentation.
- Inefficient billing processes: Case studies show that manually posting payments and denials takes more than 2 minutes per claim while robotic process automation (RPA) only takes 2 seconds. This demonstrates a need to prioritize efficiency in billing systems rather than risk losing time and money from manual work.
- Multiple timely filing limits: Labs need help keeping track of deadlines when patients have numerous coverage from various insurance companies. Although the timely filing limit typically ranges from 90 to 180 days from the date of service, Medicare, for instance, gives you up to 365 days.
Consequences of Missing Timely Filing Deadlines
Adhering to timely filing limits is crucial to your lab’s success. It will help you maintain a steady cash flow and minimize the risk of denied claims. However, if left disorganized and running late, it can almost as quickly send your revenue to the bottom. Here’s the impact of missed timely filing deadlines:
- Revenue loss: For every claim that needs to be reworked, labs lose an average $25 according to the Healthcare Financial Management Association (HFMA). Then there’s the 65% of denials that never get resubmitted, all amounting to nearly $20 billion loss in 2022.
- Compliance and regulatory penalties: Labs can face legal consequences if claims are not submitted within the stipulated time frame.
- Additional administrative burden: Resubmitting denied claims can eat up your valuable resources like admin and lab staff that are doing time-consuming work, diverting them away from core patient care activities.
Ultimately, insurance companies will refuse to pay for services that were legitimately provided and billed in good faith due to missed timely filing deadlines.
Essential Tips for Managing Timely Filing
Overall, timely filing is a “make or break” aspect of the revenue cycle. A simple mistake can cost you dollars that should have been spent improving your services and paying your billers or providers. Thankfully, the challenges of missing timely filing deadlines are preventable.
If you follow these valuable tips, you can protect yourself from timely filing denials and successfully submit claims on your first try.
- Streamline documentation processes: Switch to paperless documentation, which improves accuracy and reduces the risk of errors. At Synapse, we automate the documentation process and seamlessly integrate technology into daily workflows, giving labs more time to serve their patients and scale their businesses.
- Conduct quality checks: Regular audits must be done to identify any recurring issues or trends contributing to CO-29 denials. Any insight gained from your checks allows you to implement corrective measures. With Synapse Lab Billing, you gain access to an elite set of teams that can monitor claim submission timelines and efficiently scrub your claims.
- Enhance staff training: Empower your billing staff with the latest knowledge and technologies regarding timely filing guidelines, documentation requirements, and best practices for claims submission. Synapse works closely with Situation Expert, a Problem-Solving Learning Platform that uses 25-Rethinking tools for improved work outcomes.
- Do your notes: As soon as services are rendered, you must submit claims on the same day. We know this sounds easier than done, but doing so can ensure that all charges are sent to the insurance companies. To prepare for any denials, keep records of all claims acceptance reports and work promptly. Joining Synapse Lab Billing can help remove your mind from denials and focus on rendering lab services.
These tips were implemented by Synapse for a Sleep Laboratory that asked for claims support. The result was almost $300,000 monthly average claims charges, a 37% improvement.
Read our Case Study: Clients Achieved Highest Collections Beyond What They Expected
Ready to be on-time for timely filing?
Don’t let missed timely limits hinder your growth. Gain absolute control of your revenue cycle management by partnering with Synapse Lab Billing today. See how we can optimize your laboratory’s financial performance, stay on time with claims submission, and accelerate cash flow.
Get started with our free demo by contacting us today at (844) 384-7532 or medicalsales@synhs.com
Sources:
A review of national medical claim denial trends, with strategies to help providers decrease their denial rate. (2020).
https://www.ache.org/-/media/ache/about-ache/corporate-partners/the_change_healthcare_2020-revenue_cycle_denials_index.pdf
Course Glossary | World of Medicare. (2024). Cms.gov.
https://www.cms.gov/Outreach-and-Education/MLN/WBT/MLN9329634-WOM/wom/misc/glossary/index.html
How much revenue is your healthcare practice losing due to inefficient revenue cycle processes? (2022, February 23). Mgma.com.
https://www.mgma.com/articles/how-much-revenue-is-your-healthcare-practice-losing-due-to-inefficient-revenue-cycle-processes-
Office for Civil Rights (OCR). (2024, April 19). Change Healthcare Cybersecurity Incident Frequently Asked Questions. www.hhs.gov.
https://www.hhs.gov/hipaa/for-professionals/special-topics/change-healthcare-cybersecurity-incident-frequently-asked-questions/index.html
Poland, L., & Harihara, S. (2022, April 25). Claims Denials: A Step-by-Step Approach to Resolution. Journal of AHIMA.
https://journal.ahima.org/page/claims-denials-a-step-by-step-approach-to-resolution
Reiner, G. (2018, August 29). Success in Proactive Denials Management and Prevention. HFMA.
https://www.hfma.org/revenue-cycle/denials-management/61778/