All 50 states currently have a Clean Claim Law. The effectiveness of the laws varies dramatically ranging from South Dakota which provides for no financial penalty to Texas where the penalty can go up to a requirement on the payer to pay billed charges; that's right billed charges. The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:
- Which payers are subject to the clean a claim law (not all are),
- When a claim was submitted,
- When a request for information was received from the payer (if you receive one then it stops the 30 day clock until you respond),
- When your office responded to the information request (this starts the 30 day clock again), and
- When you received a payment or denial.
The design and implementation of the system and reporting can be challenging, but it can pay huge dividends in terms of the penalties from payers and in the way in which you will make payers take notice of your claims next time. You may actually find, as have other aggressive users of the clean claim law, that you will receive calls from managers at some of the payers assuring you they will process your claims quickly and asking you to please stop submitting complaints.
A quick way to get started with using the clean claim law is to pick a specific payer that you believe habitually delays claims beyond 30 days. Find a handful of claims that have gone past 30 days and then test the water with those claims. This will allow you to learn the basics of submitting complaints and see the impact of these initial complaints.
Copyright 2006 by Carl Mays II