Eliminate All Timely Filing Codes

Get a Clue! Eliminate All Timely Filing Adjustments
By Peter Angerhofer
Colburn Hill Group
February, 2017
EXECUTIVE SUMMARY

It is an unfortunate fact of running a revenue cycle that many claims will “die” of old age. Most often, the limit that is exceeded is actually an appeal limit triggered by multiple appeals which eventually exceed the deadline for appeal or a missed appeal window (60 or 90 days.) In a few cases, a bill will be held in the editor or at a clearinghouse past a filing limit.

However, it is extremely rare that a bill simply sits in DNFB too long and once billed is denied simply because it was overlooked, forgotten, or somehow slipped through the cracks. In short, the vast majority of claims that deny for exceeding filing limits have some other problem which caused the delay in billing.

Calling a write-off “Timely Filing Adjustment” not only fails to provide any insight into the upstream causes, it actually masks the real problem. Understanding root causes is an extremely valuable clue, which can lead to better understanding of adjustments, reduced write-offs, and ultimately increased collections.

Get a Clue! Eliminate All Timely Filing Adjustments

In the popular board game Clue, players move about the board collecting information about a murder. As they find out what didn’t happen – it wasn’t Miss Scarlet, it wasn’t with the rope, it wasn’t in the Billiard Room.... The winner eventually narrows it down to the only possibility: Professor Plum in the Conservatory, with the Candlestick! (It isn't always in the Conservatory, but it somehow is ALWAYS Professor Plum!)

The game works because players can differentiate between the various locations, suspects, and weapons. It wouldn't work if every clue was the lead pipe.

Unfortunately, too many PFS shops treat their write offs like a bad game of Clue. When they find claims that are too old to bill, or when they perform regular cleanups of aged or low balance AR, they use adjustment codes like “Exceeds Filing Limits.” In the process, they lose data that might otherwise give them insight and allow them to catch that dastardly Professor.

It is an unfortunate fact of running a revenue cycle that many claims will “die” of old age. Most often, the limit that is exceeded is actually an appeal limit triggered by multiple appeals, which eventually exceed the deadline for appeal or a missed appeal window (60 or 90 days.) In a few cases, a bill will be held in the editor or at a clearinghouse past a filing limit. It is extremely rare that a bill simply sits in DNFB too long and once billed is denied simply because it was overlooked, forgotten, or somehow slipped through the cracks.

In short, the vast majority of claims that deny for exceeding filing limits have some other problem which caused the delay in billing. Calling the write off a Timely Filing Adjustment not only fails to provide any insight into the upstream causes, it actually masks the real problem.

UNDERSTANDING THE RULES

If your adjustment codes say everything looks like a lead pipe, it is awfully hard to know that it was really the candlestick, and if you don't know it was the candlestick, then it is harder to look for the right clues to who murdered the beautiful, innocent claim which now lies at your feet.

In applied terms, if everything looks like a timely filing write-off, it appears that the problem is in billing and follow up. But unless something is seriously broken in PFS, the strong likelihood is that those timely filing write-offs are really a mix of authorization, medical necessity, billing error, and other denials. If, for example, most of your authorization denials are being buried in timely filing, you may not realize that authorizations are a problem: “The auth write-off is small, so patient access must be doing its thing – these darn payer limitations are the real problem.”

But if those auth problems were broken out and categorized appropriately, the picture might be very different. It would be easy to identify the lack of authorizations as the root cause of the problem. The answer is to eliminate all use of (or nearly all) Timely Filing write-off codes.

HOW TO WIN THE GAME

The conceptual solution in Clue is pretty simple – all the suspects and all the potential weapons are right there – just figure out which one is the murderer! A clear goal, but it takes some effort to achieve. Similarly, the conceptual approach of eliminating all Timely Filing adjustments seems simple, but it actuality it requires work to follow the clues and accomplish the task.

In some cases, posting logic is set to automatically adjust any Timely Filing denial. (In the worst case scenarios, those adjustments go to Contractuals rather than Denials. In those cases, all visibility into the size or shape of the denial problem is lost!) While this might seem like a time saver – “if the claim is past limits, the revenue is lost so why should we spend any time on it?” – but there really are two potential losses:

  • First, the timely filing denials might not be legitimate. Perhaps a bill was sent or an appeal was filed but the payer didn't appropriately load it into their system. Or perhaps the bill was delayed for some legitimate reason that might lead a payer to make an exception. So a claim that could be recovered instead is declared dead.
  • Second, even if the revenue is truly lost, it is likely the mistake will be repeated unless you can learn from this failure. Whether it is sizing the scale of the problem or localizing it by department or payer, appropriately maintained data is a key driver of improved performance. This is essential to keep recoverable claims alive in the future!

Revising the posting logic is a relatively easy step, but the next step is more challenging – if you haven't auto adjusted the claims but they still need to be written off the AR, then someone has to take the time to make the adjustment. The inclination from staff will likely be to look at the last denial and use that as the adjustment code – denied for Timely Filing, written off to timely filing – but doing that will only repeat the same error, just at greater expense.

Staff need to spend some time researching the claim (and need to be trained that expending the time is appropriate) to understand what caused the claim to deny in the first place, and using THAT adjustment code. It is more work and will take more time, but having an accurate reflection of the problems causing adjustments is vital to solving the problems. Even a careful AR manager may be surprised by how the distribution of adjustments changes when timely filing claims are re- distributed to more discrete, meaningful adjustment categories. And that AR manager may enjoy the side benefit of making themselves look good as adjustments shift from the PFS focused Timely Filing Codes to other codes that may be Patient Access or Coding related!

Encouraging staff to move away from the use of timely filing may be difficult – their training and years of experience have likely built a strong tie between the last denial code and the adjustment reason – but there is one way to make a clean break: Eliminate the Timely Filing adjustment codes.

There are very few legitimate uses of the codes to begin with, when they are used they tend to mask the real problem, and staff tend to either over-use -- or misuse -- them. It may mean there are a handful of claims that don't have an appropriate home, but the other benefits far outweigh this potential, minor cost.

Claims are going to die, for a variety of reasons, and the obvious cause of death might be a timely filing denial. But PFS managers should look beyond the obvious and take into account the root causes of those losses, which rarely are solely because of filing limits. Understanding root causes is an extremely valuable clue, which can lead to better understanding of adjustments, reduced write-offs, and ultimately increased collections.

Not to mention finally bringing Professor Plum to justice.





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