Measuring Denials for Late Submission

Question: We are interested in knowing how much denials for late claims submission are costing our practice and want some measuring stick to match up against.

Answer: I don’t know of any robust benchmark data on reasons for denials. There are benchmarks from Medicare on total claims and total value denied by specialty. (You can find these in our “Tools” section.) Note that Medicare denials are typically lower than for other payers because its beneficiaries are a more stable group, and its billing rules are public.

The thing about denials for late claims submission is that these are pretty much under your control. Your goal, really, should be zero denials. Here is how I would proceed were it me:

Track your denials for a few weeks, using the denials tracking worksheet in our “Tools” section. You want to make sure late submission is really among your key issues and fully understand how you perform now. In other words, capture your own benchmark. Capture data for a couple of weeks and extrapolate for an annual total. You can do this by specialty, but it really shouldn’t matter.

Then review your processes for getting claims out the door. What is every step in the process and where are delays happening?

Are providers documenting immediately? What is happening in billing? Is anyone reviewing transaction printouts from your clearinghouse to make sure all claims go through? In smooth operations, documentation is done at the time of service or by the end of day, and claims go out the same day.

Target one or two areas for change, then measure again to see the impact.