The double standard and inequities in the application of timeliness by payers. Rather than being resolved, the issues and disparities have intensified in 2009 as evidenced by the following:
- Providers are required to maintain timeliness of claims even while the payers' review of your clinical appeals may be delinquent. You can win the appeal and still not get paid if the claim wasn’t kept “alive.”
- Providers are required to present written proof of their timely filings of claims, records, and appeals, while payers are not required to do so.
- Payers are reducing their claims processing and review staff while the number of claims and appeals increase. Payers then openly tell your staff to allow them more time as they are behind. They do this with total disregard for timeliness statutes and contract terms, knowing full well that their only penalty is paying interest and usually only after a provider demands it. Providers’ penalty for the same offense is denial of the entire claim at issue.
Some Solutions include:
- When told by a payer that correspondence or denials you have not received were mailed on a specific date, demand written proof of delivery to your facility. If there is a pattern of claimed correspondence that you have not received then notify the payer that without their proof of timely filing you will not accept timeliness denials in from them in the future.
- Keep a log of payers’ delays in payments, reviews, etc. and demand interest.
- Use the log with payers who are persistently untimely to let them know you will not accept a timeliness denial from them until they correct their ways. After they are done laughing tell them that they can deduct a penalty from your payment, if indeed you were untimely, at the same interest rate they would have to pay when they are late. (May be testing this approach in Texas real soon. Look for the outcome.)
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