Are You Taking Advantage of the Clean Claim Laws?
Each state has passed a Clean Claim Law. The level of benefit these laws provide to medical practices and facilities starts on the low end with states such as South Dakota that provide little more than a slap on the insurance company’s wrist to states such as Texas which levy substantial financial penalties on tardy payers.
Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:
1. Which payers are subject to the clean a claim law (not all are),
2. The date the clean claim “clock” begins (i.e., the claims submission date),
3. When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
4. When your practice has taken actions in response to payer requests;
5. When you received a payment or denial.
Planning and constructing the monitoring system can be difficult, but it can have a significant impact on how quickly your claims are paid cleanly. Aggressive users of clean claim laws have actually received calls from payers assuring them that their claims will be process quickly and requesting that complaints be held to give the payer a chance to prove itself.
One way to quickly get started using the clean claim law is to run a trial on a payer that you feel consistently takes more than 30 days to ajudicates claims. Find a small number of large claims for this payer that have gone past 30 days and then conduct a trial run with those claims. This will allow you to learn the fundamentals of how to submit and monitor complaints and see the results of your complaints.
Copyright 2006 by Carl Mays II
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Tags: Healthcare
