October 25, 2023

Timely Filing & Auto-Coding: Optimizing Urgent Care RCM

For urgent care centers, maintaining a well-functioning revenue cycle is crucial to financial stability. One vital aspect of this process is timely filing of claims with payors. With reimbursements often taking up to 180 days, any delays in submitting claims can greatly impact the center’s revenue stream.
Let’s dive into the importance of timely filing, its impact on auto-coding, and how Exdionhealth’s AI-driven coding platform, can help urgent care centers minimize denials and speed up payment processes.

Understanding Timely Filing and its Importance

Timely filing refers to the timeframe within which healthcare providers must submit claims to insurance companies for reimbursement. This ensures that claims are processed promptly and payments are received in a timely manner, avoiding any delays or denials.

But here’s where things get tricky – timely filing deadlines can vary for different payors, ranging from 30 to 180 days. That’s why it’s crucial for urgent care centers to stay informed about the specific limits set by each payor they work with.

Why is this so important? Failing to meet these deadlines can result in claim denials and ultimately lead to a loss of revenue for the center. That’s why it’s essential to regularly review and update the timely filing limits of your center’s payors, so you can stay on top of things and ensure that all claims are submitted within the designated timeframe for maximum reimbursement.

The Consequences of Late Filing

Timely filing refers to the timeframe within which healthcare aThe last thing any urgent care center wants is a denied claim due to late filing. Not only does it result in lost revenue, but it also creates extra work for your staff to appeal and try to recover the payment. It’s like shooting yourself in the foot. So, let’s break down the consequences of late filing and why it’s crucial to avoid them at all costs. providers must submit claims to insurance companies for reimbursement. This ensures that claims are processed promptly and payments are received in a timely manner, avoiding any delays or denials.

First, let’s talk about Claim Adjustment Reason Code (CARC) 29. This code is a red flag for payors and indicates that the time limit for filing has expired. It basically says, “Sorry, you missed the deadline!” The worst part? CARC 29 has a high chance of prevention but a low overturn rate. In other words, it’s tough to appeal and get the claim approved once it has been denied.

This is the primary reason timely filing is so important – aside from avoiding CARC 29 denials and the headache of trying to recover lost revenue, timely filing also ensures that your center receives timely reimbursement. And let’s face it, every urgent care center needs a steady flow of revenue to keep the lights on and provide quality care to patients.

Furthermore, timely filing is also essential for maintaining a good relationship with payors. When you consistently file claims on time, it shows that you are organized, efficient, and reliable. This can lead to better contract negotiations and higher reimbursement rates in the future.

The Role of Auto-Coding in Timely Filing

One of the best ways to ensure timely filing is by utilizing auto-coding in your urgent care center. This technology automatically assigns medical codes to patient encounters, reducing the risk of human error and coding delays. Not only does this streamline your revenue cycle management process, but it also helps with accurate documentation and billing.

Auto-coding may sound like a complicated concept, but it’s actually quite simple and has become increasingly popular in the healthcare industry. It involves using software algorithms to scan patient encounter notes, identify relevant diagnoses and procedures, and assign corresponding codes.

Furthermore, auto-coding can also help reduce the workload for medical coders, allowing them to focus on more complex cases instead of spending time manually assigning codes. This can lead to faster claim submissions and a quicker revenue cycle turnaround time.

Overall, incorporating auto-coding into your timely filing process can greatly benefit an urgent care center. Not only does it help with compliance and efficiency, but it also allows for better documentation and billing accuracy. With technology constantly evolving in the healthcare industry, utilizing auto-coding is a smart way to stay ahead of the game and improve your revenue cycle management process.

How Exdion Reduces Denials and Speeds Payment for Urgent Care Centers

In addition to streamlining the coding process, Exdionhealth’s AI-driven coding platform, Exdion.Code, offers a range of features that help reduce claim denials and improve payment speed for urgent care centers. Here are some ways Exdion.Code can support your urgent care center:

Automated Claim Submission: Exdion.Code automates the process of claim submission, reducing the chances of human error and ensuring timely submissions.
Auto-Coding Integration: By integrating with EMRs and other coding software, Exdion.Code streamlines the coding process and eliminates discrepancies.
Real-Time Claim Status Tracking: With real-time claim status tracking, urgent care centers can stay on top of their claims and address any issues promptly.
Denial Management Tools: Exdion.Code’s denial management tools help identify and resolve potential issues that may result in claim denials, enabling centers to receive timely reimbursements.
Revenue Cycle Analytics: ExdionAce’s revenue cycle analytics provide valuable insights into the financial performance of urgent care centers, allowing them to make data-driven decisions and improve overall revenue generation.

Efficient Timely Filing: The Key to Maximizing Profitability

Timely filing is ultimately crucial for urgent care centers to ensure efficient revenue cycle management and maximize profitability. With Exdion.Code’s automated tools and valuable analytics, urgent care centers can stay ahead of the curve and make data-driven decisions for financial success. Don’t wait any longer to experience the game-changing solution of Exdion.Code – Schedule a free demo today and see the difference for yourself.

Frequently Asked Questions

Q1: What does it mean to optimize RCM?

Answer: Optimizing RCM means making the entire billing-to-payment workflow work smoothly — from capturing accurate patient data and correct coding to submitting clean claims and closing out payments. The goal is fewer denials, faster cash collection, and less time spent on rework so staff can focus on patient care.

Q2: What is RCM automation?

Answer: RCM automation uses software (including AI, machine learning, and RPA) to handle repetitive revenue tasks like eligibility checks, claim scrubbing, and payment posting. It speeds up processes, cuts errors, and reduces manual effort while letting staff concentrate on exceptions and higher-value work.

Q3: What is the RCM process in medical coding?

Answer: The RCM process covers every step from patient registration through final payment: verify insurance and benefits, document and code encounters, create and submit claims, manage denials and appeals, and post payments. Effective coding and timely follow-up at each step are what turn services into collected revenue.

Q4: Why is timely filing important for urgent care revenue cycle management?

Timely filing ensures claims are submitted within payer deadlines, preventing denials and revenue loss. For urgent care centers, maintaining strict filing timelines helps sustain cash flow, improve reimbursement rates, and reduce administrative rework due to missed deadlines.

Q5: How does auto-coding support timely filing and better revenue outcomes?

Auto-coding speeds up the documentation and coding process by automatically assigning accurate codes from clinical notes. This reduces manual delays, minimizes errors, and ensures claims are submitted faster — resulting in improved compliance, faster payments, and a stronger revenue cycle.

Comments

0 Likes