Surgical Billing Companies Can Use Clean Claim Laws to Increase and Speed Up Collections

Posted by Surgical Billing Partners at 9/10/2008 5:12 PM
Categories: uncategorized

Clean Claim Laws are currently in place in every state. The assistance provided by  the laws ranges from states like dramatically South Dakota which has no economic penalty to Texas where the payer sometimes is required to pay billed charges. The fundamental concept is that insurance companies must respond to a clean claim within a given period (typically 30 days for electronic claims). Systematic utilization of these laws will allow a surgical billing service or practice to significantly accelerate and increase collections. In order to take advantage of the clean claim law one must have a monitoring system built into your medical billing process that identifies:

  1. Which payers must abide by the clean a claim law (the laws do not apply to all payers),
  2. The  date the clean claim "clock" begins (i.e., the date a claim is submitted),
  3. Events that stop the clean claim  clock (e.g., an information  request from the payer),
  4. Events that restart the clean claim clock (e.g., your office replies to a payer's information request), and
  5. When you received a payment or denial.

Designing and implementing the monitoring system can be difficult, but it can have an significant impact on how quickly your claims are paid cleanly. Surgical Billing Partners has actually received calls from payers assuring us they will process our clients' claims quickly and asking us to please stop submitting complaints.

An easy way to get started with using the clean claim law is to pick a specific payer that you believe consistently delays claims beyond 30 days. Find a small number of large 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 impact of your the complaints.

Copyright 2008 by Surgical Billing Partners

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