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Ask the Experts: Timely filing measurement

May 14, 2019 3:54 pm

What is a good benchmark for a well-managed timely filing billing function as measured by the ratio timely filing denials/total denials in dollars? Most of the information I find indicates it is 1% or less but I don’t have any solid statistic on the above ratio. Can you help?

Answer 1: To best measure timely filing, measure discharge to claims submission. Take the percentage of claims submitted within a certain number of days from discharge and then break it up by payer, as the timely filing criteria can change payer to payer. This would provide a good picture of how quickly claims are being sent after discharge.

This question was answered bySuzanne Lestina, FHFMA, CPC, is director of administrative simplification policy, American Hospital Association, and a member of HFMA’s First Illinois Chapter.

Answer 2: I don’t know of industry standards, but I can share that ours is quite low, probably less than 1%.

This question was answered byRuth Landé, senior vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s Metropolitan New York Chapter.

The information provided through the Forum’s Ask the Expert service does not constitute legal advice, even when the advice is provided by lawyers. You need to obtain your own legal counsel for legal advice and consider the laws and regulations that govern your state. The content and opinions expressed are those of the Forum experts, and not that of their employers or of HFMA. HFMA does not endorse the material or warrant or guarantee its accuracy. The responses are based only on the specific facts or circumstances provided. Forum experts cannot be held liable for outcomes related to any information provided.

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