For medical billers, the end of the year isn’t just about holiday parties and New Year’s resolutions. It’s crunch time. This period is critical for ensuring that revenue cycle processes wrap up smoothly. The focus? Meeting timely filing deadlines, cleaning up A/R, and managing financial close procedures. These tasks can make or break the fiscal health of a practice as the calendar turns over.
Understanding Timely Filing Deadlines
Every payer has its own rules about timely filing. Miss these deadlines, and you could be out thousands—sometimes tens of thousands—of dollars. Commercial payers often give you a 90- to 180-day window to file claims. Medicare allows one year from the date of service. Medicaid? It’s a patchwork quilt of deadlines, varying by state.
Ignoring these timelines is like leaving money on the table. Yet, not all billers are aware of how fast these deadlines come up. It’s crucial to track your claims meticulously. Use your practice management system to flag claims approaching their filing deadline. Some systems even allow custom alerts. If not, get creative—set up a spreadsheet or use calendar reminders.
But let’s be real. Sometimes claims fall through the cracks. The end-of-year rush is the time to dig deep and make sure no claim goes unfound. A thorough audit of pending claims can reveal claims that are approaching—or worse, have passed—their deadline. You’re not just chasing pennies here. These are dollars that impact your bottom line.
A/R Cleanup: The Good, the Bad, and the Ugly
The accounts receivable ledger can resemble a neglected garden by year-end. Claims accumulate like weeds if not properly managed. Start by reviewing aged claims. Prioritize those between 90 and 120 days. Why? Because these are the claims at greatest risk of denial or write-off.
Denying claims isn’t just a payer's pastime—it’s a strategic move. Common denial codes like CO-45 (charges exceed fee schedule) or CO-97 (benefit maximum reached) often appear this time of year. Address these promptly.
For stubborn claims, use every tool in your arsenal. Payer portals are your go-to for claim status checks. Sure, they have quirks (some log you out after five minutes of inactivity), but they can save you from endless phone hold music. If necessary, escalate unresolved issues. Sometimes a direct call to the payer’s provider rep can clear up a denial faster than a dozen resubmissions.
Don't ignore small balances either. While it’s tempting to consider them negligible, they add up. Implement a strategy for settling them—whether that's writing them off en masse (if they meet your practice’s policy) or sending patient statements for collection.
Financial Close Procedures
Getting your accounts in order requires more than just chasing old claims. It’s about reconciling payments and ensuring everything balances out as you close the books for the year. First, make sure all EOBs (explanation of benefits) are processed. This might sound basic, but it's all too easy to let a few slip by when things get hectic.
Next, focus on your payment posting. Align posted payments with bank deposits. Discrepancies here can indicate billing errors or even fraud. Your finance team will thank you later.
Expense reconciliation is another end-of-year task that’s easily overlooked. Match outstanding expenses with invoices to ensure nothing has been double-billed. This is the time to resolve discrepancies—not in February, when you’re already knee-deep in a new fiscal year.
Preparing for the New Year
With your A/R cleaned up, timely filings managed, and financials in order, shift focus to the upcoming year. Re-evaluate your processes. What worked well? Where did you see bottlenecks? Gather your team and brainstorm improvements.
Consider conducting training sessions to refresh everyone’s knowledge on payer policies. It’s a good investment—every denial avoided is money saved. Also, update your systems to include new payer rules and codes for the coming year. Don't let outdated software hold you back.
Finally, set goals. They shouldn’t just be about reducing denials or improving timely filing. Think bigger. Aim for a healthier revenue cycle, streamlined processes, and a more efficient team.
Looking Ahead
As the year wraps up, remember: this work isn't just housekeeping. It's foundational. Next year's health hinges on how well you close this one out. Tackle those claims, clean up that A/R, and lock down your finances. The payoff? A fresh start and stronger footing as January rolls around.
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