Understanding the Time Limit for Medical Billing

time limit for medical billing

Are you experiencing an increase in the number of health insurance claims denied due to timely filing? You could benefit from a clearer understanding of the time limit for medical billing.

Don’t lose profit from unclear policies and deadlines. Keep reading to discover everything you need to know about medical billing time limits.

For the most reliable medical billing company in Florida, contact PracticeForces today.

 

How Timing Affects a Claim Denial

In medical billing, the provider has a time limit that determines how soon they must submit a claim before the payer denies it. While every insurance provider maintains a different “timely filing” period, the deadlines range from 90 days up to a year.

The insurance company bases the deadline on the date the provider performed the service. If you don’t file the claim before the deadline, the insurance company will deny the claim and won’t require the patient to assume responsibility.

 

Contesting a Timely File Denial

If you believe you filed the claim before the deadline and the error resides with the insurance company, you have cause to appeal the denial. Hopefully, you keep good records, as an EDI log or insurance correspondence can usually prove your case.

However, even if you didn’t file before the deadline, you could still have cause to appeal the time limit for medical billing. With a detailed letter explaining the reasoning for the failure to file on time, you could convince the insurance company to reconsider the denial.

 

The Effects of the No Surprise Billing Act

The No Surprise Billing Act provides protections for patients receiving emergency medical care, and it’s an important consideration for medical billers, too. When a patient receives emergency services, the physician can only bill them the cost-sharing amount based on comparable median in-network costs.

The insurance must pay the provider directly within 30 days, and the healthcare provider can dispute the amount for up to 30 days. This offers a much more narrow window of opportunity than 90 days or more for timely filing. If you provide emergency medical services, keep that deadline in mind.

 

Dealing With Late Payments

Are patients subject to payment deadlines? Even when you successfully file a medical claim on time, late payments from patients can still damage your cash flow. When a patient incurs an overdue bill, you have legal cause to impose late fees and interest charges.

If the patient still doesn’t pay, you can turn the case over to a debt collector, and the situation will likely damage the person’s credit report. You can only do so much, but the risk of damaging their financial future usually convinces patients to pay their balance.

 

PracticeForces Provides Reliable Medical Billing Services

Now that you understand the time limit for medical billing, you can decrease your number of denials. As a trusted medical billing provider, PracticeForces offers services, including setting up your new medical practice and credentialing.

Whether you’re looking for ways to reduce patient wait times or need to understand the importance of correct medical billing coding, we can help. To learn more, call (727) 202-5429 today.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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