Peak Medical Solutions

07/19/2025

Overview�
This article outlines Timely Filing Limits (TFLs) for dozens of insurance carriers and stresses the importance of submitting claims on time to avoid denials, revenue loss, and patient dissatisfaction.

Key Takeaways
* TFLs range from 30 days to 3 years, depending on the carrier
* Late claims often result in automatic denials with limited appeal options
* Denials can shift financial burden to patients, affecting satisfaction
* Always verify TFLs in the carrier's official manual or website
* The article’s table is a helpful reference but not a substitute for current payer guidelines

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Introduction Timely Filing Limits (TFL) are one of the most critical compliance requirements in the medical billing process. Each insurance carrier sets its own deadline for how long providers have to submit claims after services are rendered—some as short as 30 days, others extending beyond a yea...

06/19/2025

Overview�
This article explains how late claim submissions are handled by insurance carriers and what practices can do to avoid denials. It covers timely filing limits (TFLs), carrier responsibilities, and appeal strategies.

Key Takeaways
* Carriers aren’t required to accept late claims—check each contract’s TFL.
* Practices must track multiple TFLs due to varying patient insurance plans.
* Appeals may work if claims were delayed by system errors or misrouting.
* Claims can be denied on time due to missing info or lack of authorization.
* Follow up consistently with carriers during the appeal process.

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Introduction Timely claim submission is a foundational element of a healthy revenue cycle, yet even the most efficient medical practices can face challenges when navigating late claims. Understanding the rules, responsibilities, and appeal options related to late submissions is crucial to protecting

05/31/2025

Overview:
�This article highlights how Timely Filing Limits (TFLs) vary across 222 insurance carriers, with deadlines ranging from 30 to 720 days. Submitting claims on time is essential to avoid denials and protect revenue.

Key Takeaways:
* TFLs are not uniform—common limits are 90, 180, and 365 days.
* Median TFL is 180 days.
* Submitting all claims within 90 days minimizes denial risk (~0.01%).
* Billing staff must track payer-specific deadlines.
* Late claims can mean lost revenue.

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Introduction Timely Filing Limits (TFLs) are critical to the financial health of any medical practice—but not all insurance carriers follow the same rules. Each payer sets its own deadline for how long a provider has to submit a claim after services are rendered, and the differences can be substan...

05/08/2025

Overview
This article uses Etactics case study data to show how timely claim submission impacts medical practice revenue and efficiency.

Key Takeaways
* Average submission time: 9.8 days—well below the 30–50 day A/R benchmark.
* Delays hurt: Slow submissions risk missed payments and denials.
* TFL awareness: Submitting within timely filing limits is essential.
* Efficiency matters: Faster claims mean faster payments.

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Introduction Submitting insurance claims quickly and accurately is one of the most critical steps in a medical practice’s revenue cycle. Delays in claim submission can lead to increased accounts receivable (A/R) days, missed timely filing limits (TFLs), and ultimately, lost revenue.

03/25/2025

Overview
This article highlights how timely claim submission impacts reimbursement and overall revenue cycle health, using case study data to illustrate current performance benchmarks.

Key Takeaways
- Average Submission Time: Etactics found claims are submitted in an average of 9.8 days
- Benchmark Comparison: This is much faster than the 30–50 day A/R benchmark
- Process Evaluation: Practices should regularly assess delays and adjust workflows
- Faster Payment: Quicker submissions lead to quicker reimbursements

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Submitting claims quickly and accurately is essential for maintaining a healthy revenue cycle in any medical practice. The time it takes to get a claim from the date of service to the payer can significantly impact how fast a practice gets paid—or whether it gets paid at all.

03/04/2025

Overview
Timely filing limits (TFL) are the deadlines set by insurance companies for submitting claims. Missing these deadlines can lead to claim denials and lost revenue, making it essential for medical practices to track and comply with each insurer’s TFL.

Key Takeaways
- TFL Definition: The time frame within which claims must be submitted to insurers
- Denial Risk: Late submissions result in denied claims that are often non-appealable
- Varied Deadlines: TFLs range from 30 days to over a year, depending on the insurer
- Revenue Protection: Tracking TFLs helps prevent lost payments and improves cash flow

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Introduction Timely filing is the submission of medical claims within the Timely Filing Limit (TFL). The TFL encompasses the time duration from service rendered to patients and submitting claims to the insurance companies.

02/18/2025

Overview
This article highlights key medical billing formulas that help practices track financial performance and optimize revenue collection. Understanding metrics like Bad Debt Rate, Net Collection Rate, and Denial Rate allows practices to reduce losses, improve cash flow, and enhance billing efficiency.

Key Takeaways
- Bad Debt Rate (BDR): Measures written-off revenue as a percentage of allowed charges.
- Gross Collection Rate (GCR): Evaluates payments received compared to total billed charges.
- Net Collection Rate (NCR): Assesses how effectively a practice collects owed revenue.
- Denial Rate: Tracks the percentage of denied claims affecting cash flow.
- Contractual Variance: Identifies payment gaps between contracted and received rates.

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Introduction Medical billing formulas are essential tools for evaluating the financial health of a practice and optimizing revenue cycle management. By tracking key metrics like Bad Debt Rate, Gross Collection Rate, Net Collection Rate, and Denial Rate, practices can identify inefficiencies, improve

01/26/2025

Overview:
The Patient No-Show Rate (PNSR) measures how often patients miss scheduled appointments without prior notice, impacting revenue and operational efficiency. Reducing no-shows improves patient compliance, scheduling, and financial health.

Key Takeaways:
- Definition: Tracks percentage of missed appointments without prior notice
- Revenue Impact: Missed appointments cost $150–$500 each
- Benchmark: Aim for a no-show rate of 7% or lower
- Formula:
- No-Show Rate = ((No-Shows) / (Scheduled Appointments)) * 100
- Solutions: Policies, reminders, fees, and tracking reasons reduce no-shows

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Introduction Patient no-shows can significantly impact the financial health and operational efficiency of a medical practice. The Patient No-Show Rate (PNSR) is a critical metric that measures how often patients fail to appear for scheduled appointments without prior notice.

01/11/2025

Overview:
The Net Collection Rate (NCR) is a critical metric that measures how efficiently a medical practice collects revenue it is entitled to receive. By comparing actual collections to expected collections after adjustments, NCR provides insights into financial health and billing performance.

Key Takeaways:
- Definition: NCR measures actual collections relative to expected revenue after adjustments.
- Importance:
- Evaluates financial health and billing staff performance.
- Highlights inefficiencies when NCR falls below benchmarks.
- Assists in cash flow monitoring and budgeting.
- Benchmarks: Ideal NCR is 95-99%; below 90% signals inefficiencies.
- Formula:
- NCR = (Collections / (Gross Charges – Adjustments)) * 100
- Examples: Demonstrates how NCR calculation applies in real-world scenarios.

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Introduction The Net Collection Rate (NCR) is a vital financial metric that measures the efficiency of a medical practice in collecting the revenue it is entitled to receive. By considering adjustments, write-offs, and actual collections, NCR provides insights into the practice's financial health an

01/01/2025

Overview
This article discusses the importance of two critical metrics in revenue cycle management (RCM)—Clean Claim Rate (CCR) and First Pass Rate (FPR). It explains their definitions, benchmarks, formulas, and examples to help medical practices identify inefficiencies in claims submission and processing. By improving these metrics, practices can enhance their financial health, reduce operational costs, and optimize revenue collection.

Key Takeaways
- Definition of CCR: Measures the percentage of claims submitted without edits/corrections
- Definition of FPR: Tracks claims accepted or paid by payers on the first submission
- Benchmarks: A good CCR and FPR are 95% or higher
- Importance: Highlights data quality, efficiency in claims management, and cost savings potential
- Formulas: Both metrics are calculated as percentages based on claims submitted and processed

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Intro Clean Claim Rate (CCR) and First Pass Rate (FPR) are essential metrics for evaluating the efficiency and quality of a medical practice’s revenue cycle management (RCM). By measuring the percentage of claims submitted without requiring edits and those accepted by payers on the first transmiss...

12/30/2024

Happy New Year!! May your 2025 be fruitful, full of joy, happiness, accomplishments, growth, contentment, new adventures, stronger relationships, motivation, and thankfulness.

Make this year a wonderful year. 😊

12/24/2024

Wishing everyone a wonderful Christmas🎄