Use Clean Claim Laws to Make Payers Actually Pay
All 50 states currently have a Clean Claim Law. The effectiveness of the laws varies dramatically ranging from South Dakota which provides for no financial penalty to Texas where the penalty can go up to a requirement on the payer to pay billed charges; that’s right billed charges.
The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:
1. Which payers must abide by the clean a claim law (the laws do not apply to all payers),
2. The date your practice initially submits each medical claim;
3. Any events that legitimately give the payer more time to process the claim (for instance, a request for additional information);
4. When your practice has taken actions in response to payer requests;
5. The date when you received the payer’s final adjudication decision.
The idea of systematically tracking all of this information may be daunting, but with a smart system design it is possible and most definitely a worthwhile undertaking. After submitting a few Clean Claim law violation reports you will see your claims pay faster. I have seen situations where payers have actually called just to assure the practice that claims will be quickly processed.
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
Filed under: Outsourcing