Are there any benchmarks for how quickly payers should get back to us on claims and denials? If not, can we write time deadlines for responses into contracts?
Answer 1: We don’t tend to have problems with the big payers’ timeliness on payments and denials, so we have not attempted to do that. However, we do have problems with payers taking back money years later, or requesting unreasonable numbers of records for audit. Therefore, we have put parameters for those practices in some of our contracts.
This question was answered by: Ruth Landé, vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and is a member of HFMA’s Metropolitan New York Chapter.
Answer 2: You may want to start with their states prompt pay laws. These should at least give you the foundation to build on because payers (non-ERISA) are supposed to follow these guidelines. Those laws can typically be found through state associations.
This question was answered by: Suzanne Lestina, FHFMA, CPC, vice president, client innovation, AvadyneHealth, and is a member of HFMA’s First Illinois Chapter.
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