TFL and its Impact on Insurance Payments

Posted by mgsionline on February 20th, 2014

Most healthcare entities focus on how effectively they can minimize claim denials and work towards better healthcare denial management. However, they do not realize the importance of submitting claims to the Payer within the stipulated time limit. It is one of the prime reasons that affect on-time insurance payments. Many of us might speculatively think that Providers show negligence towards timely claims submission. However, the truth is they already have too much on their plate, so working prudently towards submitting all the claims is impossible. Therefore, Healthcare Providers and Facilities can get help from outsourced medical billing companies. But before checking that option, let us first understand TFL (Timely Filing Limit) and its impact on insurance payments:

What is TFL? TFL or the Timely Filing Limit is a predetermined time period within which Healthcare Providers and Facilities are expected to file their claims with the concerned Payer.

Why is TFL important? Claims that are sent to Payers after the specified TFL will not be accepted, affecting the revenue cycle management badly. Filing a claim on time before the TFL is more important than AR follow up or even healthcare denial management. With TFL issues, the chance of collecting the money is lost forever unlike the other two.

Things to Note: One important factor to be considered while filing claims is that the TFL varies from Payer to Payer. Insurance carriers can set the TFL that is as short as 30 days or as long as 2 years. It is only during the last year that the TFL has witnessed so many changes by Payers. Therefore, Providers who handle more than one insurance carrier should keep a tab on the different TFLs while performing medical claims processing and sending out claims for reimbursement.

Impact:

• As most Healthcare Entities perform physician medical billing services in house, they find it hard to balance time between patient care and medical claims processing. End of the day, they forget to send out some claims within the TFL specified by the Payer.
• Consequently, the unsent claims pile up and do not show up in the AR. No AR follow up possible since claims are unbilled or not sent. Money that is due and easily collectible is just left on the table!
• The normal cash flow gets interrupted, causing a huge loss for the Healthcare Provider or Facility.

Other Time Limits: If the claims do get filed within the TFL, there are a lot of chances for them to get denied. Sometimes, they might get denied multiple times. In such instances, an Appeal has to be sent, which also has a stipulated time limit. Again, if the Appeal is denied, the Provider has to send a second level Appeal and that has a time limit too. Healthcare entities must follow these time limits for successful healthcare denial management.

About MGSI:

The best way to send out claims within the stipulated TFL is to get help from outsourced medical billing companies. A reliable medical claims processing company like MGSI has more than 20 years of experience in performing this work prudently. This Florida-based, national medical billing company offers the right solutions to healthcare denial management and AR follow up. For more details, log on to www.mgsionline.com.