Billing

Summary

This enhancement allows for the specification of a "Timely Filing Interval" value for insurance carriers, and updates worklists to display new Deadline for Filing Date and Remaining Filing Days columns, allowing users to prioritize issues such as Billing Exceptions based on the remaining time allowed by the carrier to submit a claim.

With this change, users can identify and take immediate action when items are approaching their timely filing deadline, which will hopefully decrease denials due to missed deadlines. Conditional formatting and worklist views can also be built using these new columns.

Background

Insurance carriers may define what they call a "Timely Filing" deadline, which lists the amount of time after an exam's date of service in which a claim can be submitted. If that timeframe is missed, they will no longer pay for the patient's exam unless an appeal is made and accepted. The length of the timely filing period can vary between payers.

Feature Description

In order to assist users in identifying exams that are approaching their timely filing deadline, a new optional Timely Filing Interval for carriers can now be specified via the Carrier table, indicating the number of days the carrier allows claims to be submitted after the date of service.

The Activity, Billing Exception, and Billing Confirmation worklists will now use this value to calculate new Deadline for Filing Date and Remaining Filing Days columns, with the remaining filing days calculated as the number of days between the current date and the deadline.

For example, Carrier ABC Insurance has a Timely Filing Interval of 10 days and a patient has an exam performed on 1/15/21. Based on the Timely Filing Interval, a deadline of 1/25/21 will be displayed on relevant worklists. When viewing the worklist, on 1/16/21, the Timely Filing Countdown column will indicate 9 days remaining. When viewing it on 1/25/21, it will indicate 0 days. On 1/27/21, it will display as -2, indicating two days past the deadline.

Configuration Instructions

System Administrators must complete the following actions to enable this feature:

RIS Client

Changes to RIS Lookup Table Settings

·         Update the values for Timely Filing Interval for entries in the Carrier RIS Lookup Table Editor.

o    Setting to 0 disables calculation of filing days.

o    A negative value means that as soon as the exam is performed, it is behind by a day on filing (this is not an expected configuration).