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Master the Insurance Appeal Timeline to Fight Payer Denials

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Master the Insurance Appeal Timeline to Fight Payer Denials

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Insurance appeals

Working in healthcare is stressful enough without having to track your appeals on the calendar — but staying on time and meeting appeal deadlines will be essential if you want a strong chance of payers reversing their denial decisions.

Your best bet in setting up your insurance appeals for success will be to make sure they’re in by the deadline. Check out the following tips to help you stay on track.

The 180-Day Timeline Is Fairly Standard

In most cases, insurers only allow you 180 days (about six months) to appeal your denied claims. Although some payers may have shorter or longer appeal windows, you can typically count on 180 days to be the standard. However, it’s important to check with your payer to be sure.

When does it start? The 180-day timeline starts on the day that you’re notified that your claim was denied. So if you get a notice of claim denial on April 1 but don’t open it until May 1, your appeal window still started April 1, despite the fact that you didn’t read the denial for a month. Therefore, you’d have to file your appeal by October 1 to ensure that the payer will put the appeal through the review process.

What if You Think You’ll Miss the Appeal Deadline?

Despite your best efforts, your practice may not be able to file all of your appeals within 180 days, and in some cases, you might be afraid you’re going to miss the deadline. If this happens, your insurer may allow you to request an extension, but they will probably consider these on a case-by-case basis, and you can’t make a habit of it. Contact your payer to ask about its appeals extension processes.

Medicare maintains specific instructions for practices that need more time to appeal. Medicare wants you to share the “good cause” reason that you need more time. This can’t simply be that you couldn’t get your act together by the deadline. Instead, the good cause might be that the doctor had a death in the family, or the insurance records were damaged by a flood in the office.

You’ll send your extension request in writing and explain why you aren’t able to appeal by the deadline, while letting the insurer know exactly what prevented you from doing so. If you have evidence showing why you need an extension, submit that as well. For instance, if your provider was fighting cancer, submit a record demonstrating that he took medical leave and was not available.

Your payer will probably let you know if your extension was approved within two to three months. If they don’t approve the extension and you did miss the appeal deadline, you may not have further recourse, but it’s still a good idea to contact the payer and ask if you have any other options available to appeal the denial despite missing the appeal deadline. It never hurts to ask. In the future, however, always appeal denials as soon as possible to boost your chances of collecting.

Appeals can be confusing, but help is here! Join expert Kelly Grahovac, MBA, during her one-hour training event, Persuade Payers to Pay Up With Successful Appeals Process. Kelly will share the strategies you need to reverse denials and bring in cash. Register today!


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