In the ongoing deployment of our RCM Spotlight denial management tool for our clients, a recurring trend has emerged: Timely filing consistently ranks among the top five denial reasons for both independent and hospital-based laboratories.

Timely filing denials are a common reoccurrence for ancillary providers such as labs due to several factors, including complex workflows, data gathering challenges, and lack of visibility into real-time claim status and timelines.

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To mitigate timely filing denials, laboratories may consider implementing the following strategies:

• Process Streamlining: Optimize internal workflows to ensure swift information exchange between departments involved in claim submission. Consider the benefits of deploying software to help automate those workflows.
• Efficient Documentation: Prioritize accurate coding and comprehensive documentation to minimize back-and-forth communication during claim preparation. Add programming to the LIS and/or billing software to screen for payor edits and known reimbursement policies so that Prior Authorizations can be obtained and medical necessity can be verified prior to submitting claims.
• Automated Reminders: Implement automated systems in the LIS and/or billing software that remind staff about approaching claim submission deadlines, reducing the likelihood of missed windows.

 

RCM Spotlight offers a distinct advantage in addressing timely filing denial issues:

• Claim Tracking: RCM Spotlight provides real-time visibility into potential bottlenecks, enabling proactive management.
• Denial Work queues: The system generates automated work queues for quick resolution of issues.
• Data Analysis: Through its advanced analytics, RCM Spotlight can identify patterns contributing to timely filing denials, enabling process improvements.

In conclusion, timely filing denials pose significant challenges for laboratories, often resulting from complex workflows and information gaps. Proactive measures, such as process streamlining and automated reminders, can mitigate these issues. RCM Spotlight’s unique capabilities in claim tracking, work queues, and data analysis position it as a valuable tool to identify and address Timely Filing denial trends, ultimately enhancing revenue cycle management for laboratories.

Please feel free to reach out to us directly for a free consultation or trial of RCM Spotlight if you have any questions.

 

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