Pressed for Time: New Deadlines for Filing Anesthesia Claims

-->October 28, 2019Billing & Compliance Alerts

    Time marches on.  The clock is ticking and the days are flying.  Though, at times, we would like nothing more than to slow things down, the passage of time propels us into the maelstrom and compels us to take action.  Who among us has not experienced the stress of having to meet toxic timetables and dreaded deadlines?  It’s just part of our daily reality.  In 1895, H. G. Wells published a novella about an inventor who built a machine to master time; but, by the end of the story, time had gotten the better of the inventor.  Despite all attempts to tame it and control it, time tends to have the last word.

    Yes, there is little doubt that the underlying pressures that many Americans feel in this fast-paced society are due, in large measure, to the reality and inevitability of the fourth dimension—time.  In recent days, one health insurance company has added one more time pressure to our increasingly hectic schedules.

    Running Short on Time

    Anthem Blue Cross Blue Shield Healthcare Solutions (Anthem) has instituted a change in its timely filing deadline.  What was once a 180-day allowance for in-network claims (365 days for non-participating claims) has now been considerably shortened.  Notifications have been issued by most of Anthem’s state subsidiaries to the effect that these previous filing deadlines have been changed to 90 days for all professional claims.

    States that have issued advisories of this change include California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin.  This notification was noticeably absent from Anthem’s Virginia website at the time of this writing.  However, this may have been an oversight, as one Anthem representative has informed us that the new 90-day deadline is applicable to all Anthem states.

    Notifications from some states, such as New Hampshire and New York, specified the change was only applicable to Medicare Advantage plans.  In California, only Anthem Blue Cross plans are at issue, as Blue Shield operates independently.  By and large, the typical notification found on many of Anthem’s subsidiary sites contains the following or similar language:

    Effective for all claims received by Anthem on or after October 1, 2019, all impacted contracts will require the submission of all professional claims within ninety (90) days of the date of service.  This means claims submitted on or after October 1, 2019 will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.

    These Anthem notifications typically include the additional instruction that if the Anthem plan acts as the secondary payer, the 90-day period will not begin until the provider receives notification of the primary payer’s responsibility.

    As a means of comparison and unless otherwise stipulated by state law or contract provisions, the following commercial payers hold to the following filing deadlines for most in-network claims, in most states:

    • Humana – 180 days; 90 days for ancillary providers
    • UHC – 90 days
    • Aetna – 120 days
    • Cigna – 90 days

    So, Anthem is not alone in the 90-day deadline for claim submission from the date of service.

    Time is of the Essence

    The upshot of all this is that we now have far less time to process these Anthem claims.  In fact, that time has been cut by half for in-network services, and we now have nine fewer months to submit out-of-network claims.  What this effectively means is that more Anthem claims could be denied—unless certain measures are taken by providers in conjunction with our billing staff.  To lessen the likelihood of denials due to timely filing errors, we recommend the following strategies:

    So, Anthem is not alone in the 90-day deadline for claim submission from the date of service.

    1. Ensure Expeditious Delivery of Your Records.  It goes without saying that providers will need to tighten up on their timely delivery of medical records, reports and progress notes to our billing office.  I will never forget hearing years ago about a particular anesthesiologist who routinely waited several weeks to submit his documentation.  He literally drove around with stacks of anesthesia records on the back floorboard of his car, turning them over to the billing staff only when so moved.Those days of lackadaisical nonchalance are coming to an end.  Medical groups should have a systematic process in place to get the medical record from the provider to our billing office within 48 hours, where practicable.  Every day of delay in the completion and delivery of the record increases the possibility of not getting paid.  Now, we realize not all groups want to abide by this 48-hour time recommendation.  Some wish to hold claims for multiple days for various and legitimate reasons.  However, given these new time limits, we would ask that you work with your ABC account executive to appropriately adjust any built-in delays you may currently have in place—at least as it concerns the submission of Anthem cases.
    2. Verify Insurance Coverage Quickly.  The fact is many claims that run afoul of timely filing deadlines were initially filed with the wrong insurance.  The hospital takes down the wrong information, which we then receive, and it may take days or weeks to discover the error. With the time window narrowing on Anthem claims, it is critical that our clients work with us to develop strategies to reduce incorrect insurance errors in the claim submission process.  This may be as simple as the group sending us an image of the front and back of the patient’s insurance card, where the facility allows such information to be forwarded.
    3. Promptly Transmit Provider Changes.  Often, claims can be initially denied due to “wrong provider” errors.  To avoid costly delays due to such errors, groups—whether independent or employed—need to send our provider enrollment (PE) staff accurate credentialing information at the outset of a new provider’s tenure.  In addition, whenever there is a change in an existing provider’s location, name, status, etc., that information should be quickly communicated to our PE personnel so that they, in turn, can provide the new information to the payers, as required.  Alternatively, such information can be sent directly to your account executive.

    No Time Like the Present

    Yes, we are more pressed for time as it concerns Anthem’s new deadlines.  Realizing, then, the increasing importance of swiftly submitting these claims, this may be a good time for our clients to implement the recommendations listed above.  When you have these strategies and capabilities in place, the concern over the compressed period to submit your Anthem claims should be significantly eased.  You can move ahead with confidence that our combined efforts will, more often than not, secure appropriate reimbursement for services rendered.

    As your billing partner, we are always here to listen to your concerns and provide guidance that is informed by decades of experience.  If you have a question or request concerning this or any other topic, please contact your account executive.

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