Get the Lowdown on State Prompt Pay Laws
When paying your medical claims, here are some prompt pay laws that each payer must follow.
Validate which laws apply to your practice
Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer doesn't pay the claim in a timely fashion, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames vary from 15 to 45 working days, with 30 days about the average.
And if you are a little adventurous, you could search for your state law on the Internet. But then that reading through state laws and their multiple exceptions, references to other sections of state law, and 'legalese' can make this a very difficult exercise.
Better choice: Take advantage of your local or state medical society and the experts they employ to find out if your state has a prompt pay law, and to which insurance companies it applies. The medical societies are on your side and will give you the proper information.
Note of caution: State prompt laws don't apply to federal insurers since the Federal Government dictates that clean claims must be paid in 30 days for Medicare Part B.
If a state wants a prompt pay rule that is longer or shorter, they surely can do that with reference to other payer services. However Medicare rules are federal and span across the length and breadth of the country.
You should hold your payers accountable
If your private payer regularly becomes late on paying claims and fails to meet prompt pay law requirements, you could be due interest. For instance, in Illinois insurers must pay interest at the rate of 9 percent each year, as per the Illinois state Web site. New York pays interest at either 12 percent per year or the state's corporate tax rate, whichever is more.
Good practice: Here are three steps to help you fight back against insurance companies that are continually slow to process your clean claims:
You should prove your own timely filing. Make it a point to send a printed copy of your electronic proof of timely filing. Most billing software programs can print out an electronic confirmation from the carrier by confirming it received the claim, including the date of receipt. This is a good form of proof that the payer received your claim and when. Write and send a letter stating the payer is violating prompt payment laws. Consider threatening legal action or a complaint with your state insurance commissioner if you don't get payment. Get in touch with your state's insurance department. If a payer is regularly slow in paying your clean claims, take the problem to an authorative body. Concluding note: Most states use consumer hotline numbers so that you can get in touch with the insurance department directly if you want to dispute whether your claim was paid on time. You should get in touch with your state medical association or insurance department if you feel your claim wasn't paid in a timely manner. For more on the state's prompt notes, sign up for a medical coding guide like Supercoder.
Validate which laws apply to your practice
Each state requires private insurers to pay all clean claims within a certain time frame. If the insurer doesn't pay the claim in a timely fashion, then the payer is subject to paying interest on the charges owed to the practice (or directly to the beneficiary). Most time frames vary from 15 to 45 working days, with 30 days about the average.
And if you are a little adventurous, you could search for your state law on the Internet. But then that reading through state laws and their multiple exceptions, references to other sections of state law, and 'legalese' can make this a very difficult exercise.
Better choice: Take advantage of your local or state medical society and the experts they employ to find out if your state has a prompt pay law, and to which insurance companies it applies. The medical societies are on your side and will give you the proper information.
Note of caution: State prompt laws don't apply to federal insurers since the Federal Government dictates that clean claims must be paid in 30 days for Medicare Part B.
If a state wants a prompt pay rule that is longer or shorter, they surely can do that with reference to other payer services. However Medicare rules are federal and span across the length and breadth of the country.
You should hold your payers accountable
If your private payer regularly becomes late on paying claims and fails to meet prompt pay law requirements, you could be due interest. For instance, in Illinois insurers must pay interest at the rate of 9 percent each year, as per the Illinois state Web site. New York pays interest at either 12 percent per year or the state's corporate tax rate, whichever is more.
Good practice: Here are three steps to help you fight back against insurance companies that are continually slow to process your clean claims:
You should prove your own timely filing. Make it a point to send a printed copy of your electronic proof of timely filing. Most billing software programs can print out an electronic confirmation from the carrier by confirming it received the claim, including the date of receipt. This is a good form of proof that the payer received your claim and when. Write and send a letter stating the payer is violating prompt payment laws. Consider threatening legal action or a complaint with your state insurance commissioner if you don't get payment. Get in touch with your state's insurance department. If a payer is regularly slow in paying your clean claims, take the problem to an authorative body. Concluding note: Most states use consumer hotline numbers so that you can get in touch with the insurance department directly if you want to dispute whether your claim was paid on time. You should get in touch with your state medical association or insurance department if you feel your claim wasn't paid in a timely manner. For more on the state's prompt notes, sign up for a medical coding guide like Supercoder.
Source...