The importance of timely claims submission is not lost on physicians or their staff and is an integral part of the revenue cycle management (RCM). The dynamic nature of the health industry and the reforms has further exacerbated the already volatile situation when it comes to claim submission, denials, and re-submissions. There are numerous factors that affect the efficiency of the claim submission process and these may range from type-o errors to other issues regarding medical billing and coding or policy matters. Moreover, the tendency to deny or reject claims based on simple errors seems to be the unwritten principle of most of the insurance companies in the market which further hampers the whole RCM process, thus affecting physician revenue and patient satisfaction.
The most important aspect in RCM is the timely filing of claims that has an undeniable impact on how much and when the providers get paid. There are, however, numerous hurdles in timely filing of claims that can be encountered in a clinic and by their staff or even medical billers and coders:
- One of the most common hurdles in timely filing of claims is the fact that simple errors can and do occur while submission and this rate is even higher for an in-house staff that juggles with numerous issues and interacts with numerous payers
- The biggest hurdle in timely filing is resubmission which is when the claim is denied and filed again due to some error or incompetence on the part of insurance companies
- However, there are other more practical hurdles such as unavailability of time, work pressure on staff, increased demand, and other pecuniary factors that influence the timely filing of the claim
The most important factor that affects the timely filing or submission of claim is whether the in-house staff is handling claim submission or interaction with payers or if the complete RCM process has been outsourced to a professional billing company that not only has competency and professionalism but is also professional and scientific in its approach. The dynamic insurance market also plays a role in the timely submission of medical claims and the rules and regulations governing various providers are also responsible for influencing the way in which claims are filed. Usually claims should be filed within 30 days of the day when the service(s) was provided; however, this may differ according to the provider policies and government guidelines.
There are many ways of dealing with the issue of untimely claims submission and its inevitable negative repercussions. However, the most important method of ensuring that claims are filed on a timely basis is to analyze the whole process of RCM so that the lacunae and repeated errors can be isolated and corrected. For instance, if a provider is denying more claims or is denying claims even when filed in a timely manner, then such situations need to be analyzed and resolved immediately. This process of finding habitual and regular errors in the process of timely submission can be easily handled by a medical billing specialist in a better manner compared to a novice or an in-house staff member.
The inevitable impact of the health reforms on claim submission and RCM is palpable in the form of adoption of 5010 platforms, Electronic Health Records (EHRs) and numerous other factors and requires specialized training and skill that can only be achieved by dedicated professionals who are capable of submitting claims in a timely manner. Moreover, recent issues such as the rapid changes in legislation, intervention of the Supreme court, legal, financial, and administrative issues surrounding ‘Obamacare’ have made it necessary to have specialized professionals who can keep up with the changes and assist in timely submission of medical claims.
Medical billers and coders at www.medicalbillersandcoders.com are not just HIPAA compliant and legally updated but also perform research and analysis of claims and strive to achieve the maximum efficiency through a scientific approach, be it claims submission or accounts receivables. To find more information and for consultancy as well as other medical billing and coding services.