Medical billing can be complicated and lengthy, depending on the services you provide your clients. But wait too long, and you could find yourself with a pile of denials because you failed to file your claims promptly. Medical billing time limits differ by state and by insurance provider. Below, we outline the guidelines so you can stay on top of your claims and avoid losing out on revenue from unclear policies and deadlines.
Why Medical Billing is Subject to Time Limits
Insurance companies set deadlines for the timely filing of medical bills and claims because it contributes to customer satisfaction and enhances operations. Enforcing billing deadlines enables insurance companies to turn patient bills around more quickly. This helps patients budget for medical expenses more accurately and protects them from surprise bills for procedures they had years earlier.
Typical Medical Billing Time Limits
Insurance companies set their own time limits, so it’s best to consult your insurance contract with your provider. In general, medical billing time limits range from 90 days to 180 days. Medicare will give you a full year to submit a claim.
What this means is that if a patient comes in for care on March 10, you need to file a claim with their insurance provider by June 10 for providers with a 90-day limit or September 10 for providers with a 180-day limit. If you don’t file the claim until November, the insurance company can deny it. In this case, you would have to file an appeal or risk losing revenue, negatively impacting your cash flow and disrupting your operations.
Governmental Regulations
State governments advocate for patient welfare, and many have enacted legislation to reduce instances of surprise medical bills. Much of this legislation (the No Surprises Act) covers out-of-network providers and how they estimate and bill for services. However, some states also have regulations on how long you can submit a claim after a medical service. Stay updated with the regulations in your state, and make sure you keep detailed records to comply with the requirements and avoid penalties.
The No Surprises Act also limits balance billing to out-of-network patients, which could also impact your revenue if you provide services to people who aren’t in your network.
Benefits of Medical Billing Time Limits
There are many compelling reasons to adopt the practice of submitting medical bills within the required time limits. The first is that you reduce the risk of having your claim denied. Promptly billing insurance providers helps you get paid faster, boosting your revenues and cash flow. Other benefits of adhering to these limits include:
Reducing the Risk of Claim Errors
When you’re billing for services shortly after providing them, it’s easier for your medical billing team to find detailed information on the visit. They don’t have to wade through multiple records to find out which services you provided and code them in each bill.
Catching Errors More Quickly
If one of your medical billers makes a mistake on a patient bill, the insurance company will likely deny the claim immediately. By submitting claims within the required window, your team can resolve claim denials more quickly, allowing you to recoup your payment faster.
Staying in Compliance
As federal and state guidelines evolve to protect patients, you and your medical billing team need to stay on top of these regulations. Submitting your claims within medical billing timelines lets you stay in compliance and avoid penalties.
Increasing Customer Satisfaction
Submitting your bills to insurance providers on time allows them to bill their clients faster, streamlining the billing process. Timely billing also reduces the time it takes for patients to receive bills for their portion of the service, which can ease their frustration with the process.
Setting medical billing time limits can also impact patients' ability to pay for your service. Unless you offer emergency services, many patients plan and budget for medical treatments throughout the year. If you’re not billing them close to when they’re receiving treatment, they might not pay you as quickly because they have other financial responsibilities that conflict with their medical budget.
In addition, your patients get better care because they don’t have to delay or postpone treatments.
Appealing Timely Filing Claim Denials
Even when you’re submitting claims within the timely filing window, you run the risk of denials. Your patient may have given you incorrect insurance information, or you could have made a mistake on the claim form. In this instance, you can file an appeal, but you need the records to back you up.
First, check with the provider to see if they require specific forms for timely filing of claim denials. You will have to fill out this form with proof showing that the initial claim was filed within the specified timeline and how you corrected your errors and resubmitted it.
If you didn’t file within the specified timeline, you can still appeal, but it’s harder to get approved. Make sure you have a valid reason for filing a late claim and attach your records to the appeal. For example, consider the scenario where your client changes jobs and mistakenly believes their insurance coverage hasn't commenced yet. They paid out of pocket for your service and then found out that their insurance took effect before their appointment. In this case, they may ask you to bill their insurance provider.
How PUREDI Can Help You Stay Compliant
Customize your medical billing workflow with PUREDI to process your claims on time. Professionals with industry knowledge developed our cloud-based, intelligent platform. Our solution integrates with your electronic health records, allowing your team to research and submit claims promptly.
Use the software to check your bills for errors before you submit them so you can improve your payment times and manage your billing within the required time limit. Take advantage of customized reports to see how many of your bills are being submitted within recommended windows. With this data, you can set performance metrics for your billing team and improve your timely submittals.
Schedule a demo today to find out more.
