Impact Insights

Timely Filing: Optimizing Revenue Cycle Team Performance

Jill Berger-Fiffy

Timely filing write-offs are preventable, but avoiding them requires diligence on the part of billers and leadership.  A timely filing write-off is a charge deducted from a claim because the claim is submitted beyond the agreed upon timeframe developed during the contracting process. Consider using a multi-faceted approach to prevent claim denials and write-offs.

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7 Ways to Optimize Biller Performance and Prevent Timely Filing Write-offs:

1. Observe the denial workflow in your office and ensure staff are working accounts based on the oldest and largest dollar amount.  Sorting claims in the workqueue by “age” ensures staff are working claims close to timely filing limits.  Also, review account notes.  Claims which have been appealed or those with no response require a phone call to the payer.

2. Add an “exposure report” (claims approaching timely filing limits) to standardized reporting.   It is fairly standard for a practice to report and review Accounts Receivable buckets (i.e., 0-30, 31-60, 61-90). The “exposure report” would be similar to a “reverse aging” report and provide increased visibility for managers and staff.

3. Ensure staff are working claims in all of the A/R buckets and not just a single bucket or only the easy claims. Compare A/R buckets to benchmarks, such as the Medical Group Management Association (MGMA) or Health Finance Management Association (HFMA).

4. Activate a cohesive on-boarding and supervision process for billers.  Compare staff quality and quantity against each other.  Detailed reporting can provide visibility to the work being performed.  Ensure the work performed is in line with your policy and procedures and expected production level. Coach staff to improve their performance.   Conducting a quality audit will help to provide objective feedback and improve staff performance.

5. Encourage staff to alert their manager of trends in which payments are suddenly less than the “expected” payment rate.  Often, staff will begin seeing a pattern before leadership realizes there is a change in policy with a payer.  Utilize software that can compare changes and shine a light on a reimbursement issues.

6. Use LEAN strategies such as visual displays and “huddles.”  Providing visualization of trends helps ensure everyone understands the current and future state.  Team huddles can produce solutions to barriers.  Develop a cohesive strategy with the team then, hold staff and managers accountable for the work that is done.

7. Establish a quality and a quantity review process to understand staff workflows and mitigate denials.  Successful billing is about finding the right combination of quality and production.

In summary, the physician billing process should include tools to reduce/eliminate timely filing write-offs.  Visibility, reporting and supervision are integral to optimizing your team and to ensuring the right combination of quality and production.

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