Have you ever analyzed how long Medicare takes to pay your claims?  We did!

So you’ve seen your patient, you’ve closed their chart and filed a Medicare Claim, and now the waiting game begins.  But, have you ever wondered if your ‘Waiting Game” is consistent with the clinic down the street or the one clear across the United States?

You’re in good company, we wanted to know the answer to this as well!  We figured, there had to be lot of providers wondering if the time it takes them to get paid by Medicare is well, consistent with the industry.  So, we did some digging, and some number crunching, and built a considerable ‘sample’ to find out what the average time was that Medicare took to process its claims.

And, since we enjoyed it so well, we decided to analyze how long it takes Blue Cross to pay my claim as well.

We knew this would vary from State to State and from Mac to Mac, but shockingly, the variance wasn’t that significant.

First of all, what is a MAC?

A MAC is a Medicare Administrative Contractor.  Each state has a MAC who processes their Medicare Claims.  There are currently 12 (Medicare Part A&B) MACs and 4 Durable Medical Equipment MACs in the United States.  These MAC’s process the Medicare claims for nearly 60% of the total Medicare beneficiary population, or 37.5 million beneficiaries.  If you’re interested to find out who your MAC is, this link will help.

What was the makeup of our sample?

We wanted to have a broad sample of Specialties and Locations in order to ensure the accuracy of our findings.  Our specialties included; Physical Therapy, Cardiology, OB/GYN, Internal Medicine, Urgent Care, Family Practice, Orthopedics, and Podiatry.  The locations we sampled utilized the following MAC’s:  Palmetto, WPS, Noridian JE and JF, and FCSO.

These claims were all Medicare Part B claims and were all sent electronically through our clearinghouse.

We sampled a total of 10,100 Medicare Claims, and found the average time frame it took for the respective MAC to pay the claim was 16.36 Days.  We had a payment variance from high to low of 5.35 Days.

How did we calculate the time interval

Our practice management system allows us to pull data for a fiscal date range which will tell us a host of information about all the claims filed during this fiscal period.  We performed a calculation using the ‘Days Function’ in Microsoft Excel, and calculated the elapsed time between the date filed and the date posted.

Here is the breakdown by specialty:

Cardiovascular-17.33

Family Practice-14.47

Physical Therapy 15.75

OB/GYN-18.80

Urgent Care-15.62

Internal Medicine-16.74

Orthopedics-18.73

Podiatry-13.45

According to a cursory Google search, this site states that Medicare takes about 30 days to pay a claim.  However, we’re thinking they’re referring to the processing of Paper Claims.  This site says when a claim is submitted by a HIPAA compliant EMC, it should be on the Payment Floor by the 14th day.

What is the Medicare Payment Floor.

Well, it’s not really a ‘Floor’ like the New York Stock Exchange or your local Ford dealers showroom.  They don’t have representatives shouting out “Processing the 99213 for the Main Street Clinic” or “Denying the 99215 for the Mad Zepplin Physical Therapy Clinic”.  It’s simply a term used to describe a specific time frame.  This time-frame is determined by counting the number of days since the day the claim was received by Medicare.  And the count begins the day after the day of receipt.

So, given that there is also additional time needed to ‘Post’ the payment once its received, we believe our 16.36 average is right in line.  Between what the payment floor time-frame is and our 10,100 claim average of 16.36, its safe to assume a number between 14 and 16.36 should be very accurate, for many different MAC’s.  If you’re experiencing a number higher than ours, you may want to review your process and see where the breakdown is occurring.  If you need help, let us know.

So, how long does it take Blue Cross Blue Shield to Process Claims?

Blue Cross is a little more complex when it comes to measuring how long it takes to pay my claim, and its harder to quantify one exact number for this analysis.  Mainly because there are 36 Independently operated subsidiaries of Blue Cross that provide healthcare plans to 1 in 3 Americans, with each having its own payment process.

If you’re wondering who your specific Blue Cross Subsidiary is, look at the first 3 letters of the Subscriber ID.  These 3 letters represent the subsidiary who processes your claims.  Ours is ‘ZES’, which is Blue Cross Blue Shield of Tennessee.  If you’re unsure who yours is, you can look it up here.

Blue Cross Prefix

Our Analysis of Blue Cross Blue Shield Payment Payment time interval

We sampled 6 States; Tennessee, Arkansas, Missouri, Montana, Mississippi, Florida.  We analyzed 11,700 Blue Cross Claims using the same medical specialties we used in the previous Medicare sample, with one addition; Pediatrics.  Our Payment variance from high to low was 6.07 Days.

The Lowest or quickest payment we found was 8.52 days for Physical Therapy in Montana, and our longest was 14.59 days for Pediatrics in Missouri.  This graph shows where all the specialties came in at:

Medicare Payment Time Frame

Some fallacies in our sample:  While we would have liked to have a larger pool of States to draw data from, these are currently the states we bill Blue Cross claims in.  As far as specialties, we would have liked to have more represented, though we believe those we sampled provide a good understanding of what the turnaround time should be for a Blue Cross claim.

We hope this helps you to be able to diagnose your practices Medicare and Blue Cross payment turnaround.  If you need help, please contact us and we’d be glad to perform an audit to see where improvements can be made.

 

 

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Medicare

Medicare is the federal health insurance plan for people over age 65 or who are long-term disabled. Eligibility and enrollment is through the Social Security Administration. Medicare has changed over the years, offering additional options for healthcare insurance. Traditional Medicare includes Part A for hospital insurance and Part B for medical coverage, meaning it covers doctor visits and other medical bills. Part C, also called Medicare Advantage, allows private health insurance companies to provide Medicare benefits. Part D is a prescription drug plan. It’s important to carefully assess your healthcare needs and determine which plan is right for you.