Author Topic: Timely Filing for Patient?  (Read 3893 times)

dfranklin

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Timely Filing for Patient?
« on: December 02, 2009, 04:46:53 AM »
Is there a timely filing limit for billing the patient?

If we have claims from say 7/1/08 that were denied by the carrier due to past the timely filing limits, can we bill the patient for the full amount?

I recently picked up a client that their previous biller did not bill a lot of claims. I have tried to get them paid but the ones that are denying can we make patient responsibility?

Michele

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Re: Timely Filing for Patient?
« Reply #1 on: December 02, 2009, 09:20:52 AM »
The laws vary state to state so you need to check your state laws.  However, if the provider is in network with the insurance carrier then it is against his contract to bill the patient if the claims were denied for timely filing.  I know I would be a very unhappy patient if I got a bill because my doctor's office didn't file the claim in time.  The dr needs to consider that before making all of his patients pay (literally) for his billers negligence.

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Anand

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Re: Timely Filing for Patient?
« Reply #2 on: December 03, 2009, 02:12:50 AM »
The laws vary state to state so you need to check your state laws.  However, if the provider is in network with the insurance carrier then it is against his contract to bill the patient if the claims were denied for timely filing.  I know I would be a very unhappy patient if I got a bill because my doctor's office didn't file the claim in time.  The dr needs to consider that before making all of his patients pay (literally) for his billers negligence.

Michele


I agree with Michele here.. I would also suggest to coordinate with the Dr on this regard...

dfranklin

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Re: Timely Filing for Patient?
« Reply #3 on: December 03, 2009, 06:16:23 AM »
I will have to get back to him as he was the one that was asking me if we could still bill these patients.  I will tell him that we have to check the laws in Pennsylvania.  Since he is aksing me I presume he wants to bill the patients (they probably for the most part are no longer current patients, so he is trying to recover what he can), but he was not sure if we could or not. 

Do you know where I can go to check on the laws for him or should I leave it up to him to research and decide as he would ultimately be the one responsible correct?

Anand

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Re: Timely Filing for Patient?
« Reply #4 on: December 04, 2009, 01:32:05 AM »
I will have to get back to him as he was the one that was asking me if we could still bill these patients.  I will tell him that we have to check the laws in Pennsylvania.  Since he is aksing me I presume he wants to bill the patients (they probably for the most part are no longer current patients, so he is trying to recover what he can), but he was not sure if we could or not. 

Do you know where I can go to check on the laws for him or should I leave it up to him to research and decide as he would ultimately be the one responsible correct?
Well in a broader prespective YES, however we got to check the state law, if it permits - I would bill the patient. I really dont think of any certainity that patient would pay for the bills which are pretty old and moreover its due to the negligence but as you mentioned we can try to collect as much as we can the rest should go to proivders. :(. I would also try to work on some discounts and budget payment methodology..

dfranklin

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Re: Timely Filing for Patient?
« Reply #5 on: December 04, 2009, 06:21:36 AM »
Thank you very much for the feedback!

Steve Verno CMBS, CEMCS

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Re: Timely Filing for Patient?
« Reply #6 on: December 04, 2009, 08:37:10 AM »
Timely filing is under the juridistimction of
1.  State Laws.
2. Federal Laws.
3.  Provider Contracts
4.  Patient benefit contracts.

1.  State Laws:
some states do have timely filing limits. For example, in Florida you have  FS 641.3155 and 627.6131, both state the provider has 6 months from the date of service AND from the date when the provider receives the correct insurance information.  For Medicaid, in Florid, you have one year.

2.  Federal laws:
Federal has juridiction over Medicare, ERISA, and Federal Employees.  Medicare usually has a 15 month timelimit.

3.  Provider Contracts. 
As billers we need to know the contracts our provider has signed.  The timelimit that is listed in the contract may supersede current laws.  Instead of a 6 month or 15 month timeframe, the provider agreed to accept a 90 day time limit which is the usual timeframe in most provider contracts.

4.  Patient Contracts

This is the contract the patient has with the insurance company when the patient obtains health care coverage themselves or it is provided as a benefit of employment. With some patients, the time limit could be 30 days to 90 to 2 years.  To know the pecifics, you need to review the patient's benefit manual or summary plan description.

KNowledge is power.  The more you know, the better ammunition you have to fight back with frivolous timely filing denials. 


I see many e-mail and postings about how a previous biller never sent the claims in a timey manner.  It should be understood that if this happened, the problem wasnt with the insurance company. They were available to receive the claim.  If the time limit has passed, The provide may have to eat the claim because it was his fault for not ensuring that his biller did their job.  The biller represents the provider.  If there is still time to get the claim in, then do so.
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PMRNC

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Re: Timely Filing for Patient?
« Reply #7 on: December 04, 2009, 04:51:03 PM »
You can save yourself a lot of time and headache by just calling the carrier for their timely filing limit. I doubt you will find a carrier who's limitation is not up to par with state laws. Much easier to call the carrier. One phone call :) 
Linda Walker
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dfranklin

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Re: Timely Filing for Patient?
« Reply #8 on: December 04, 2009, 09:02:16 PM »
To clarify:

My question was not about the laws with timely fiing with the carriers.  Their previous biller screwed up and did not get them in. I have tried to still submit and ask for exceptions etc. But my question was what is the laws (where do I find them) on sending bills to patients for these?  When is it too late to send the bill as patient responsibility to them?  And I see that some are saying if we are past timely filing with the carrier and provider is in network then it is agains the contract to bill the patient? 

This brings a new question: What if we are past the timely filing and it was not biller/providers fault (ie correct insurance info, etc)?  Just curious as to the difference and how to "prove" the case either way....

See the main reason is I am dealing with a chiro and their reimbursement from the carriers is typically minimal and there is a lot of patient responsibility anyway. So just because lets say on a $300 claim we are not getting the $30 dollars or so from the insurance because it was not filed timely, why should the doctor lose the $270 patient responsibility portion? This was going to be billed to the patient anyway....so how long do we have to send patient responsibilty bill to them (legally or contractually)? 

Steve Verno CMBS, CEMCS

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Re: Timely Filing for Patient?
« Reply #9 on: December 04, 2009, 10:29:21 PM »
Linda has an excellent idea.  Here in Florida, I did that.  Every insurance company I spoke with said they had a 90 day time limit.  Ive sent claims 7 days after the patient was seen (this is because with emergency medicine, you have to wait for the hospital to send you the copy of charts and patient info)  For example, patient seen on jan 1.  Claim went out to insurance electronically on Jan 8.  The insurance company denied the claim on Feb 15 for not submitting the claim within 90 days of date of service.  When shown Florida has 6 month timeframe, they ignore this until a complaint is sent to the office of insurance regulation.

Every insurance company where Ive negotiated contracts with, want between 45 and 90 days for claim submission, when informed of Florida's time limit, the insurance company responds with, we have our own and every doctor agrees with our timeframe.  Our contracts states claims will be submitted within claim submission timeframe under applicable State or Federal Laws. The insurance company;s dont like it, we tell them if they wish us to be contracted, this is a make it or break it requirement. 

Most State timely filing laws are listed in the insurance laws.

Many insurance contracts I have seen do not allow patient balance billing if the provider failed to submit the claim within the contracted timelimit. 


Our practice policy is, if the patient withholds insurance information until aftr the State time limit to submit the claim, we have the patient pay if the claim is denied.  Howeverk we have been working with our cotracts to close this loophole.  We have language added to state if the patient wilfully withholds correct insurance information until after any and all timely filing limits, we can still submit the claim and the crrier has to pay.  The practice policy is if the billing company screwed up and didnt send the claim in a timely manner, we didnt hold the patient responsible for the screw up. 

A couple of years ago, we had a huge problem with New York Medicaid paients withholding Medicaid info.  They wee treated as uninsured .  The account became delinquent and was sent to our collection agency.  It was whe at collections that the patient revealed Medicaid coverage.  We would get a call from Medicaid telling us we had to write the bill off.  We refused.  I wrote to the Department of Health and Human Services.  CMS responded saying if the patient made a  freedom of choice decision to present themselves as an uninsured or self pay patient, we were entitle to teat them as a self pay patient.  Ive ised that letter to get medicaid and te medicaid HMO to pay the claim even after their timely filing limit
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PMRNC

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Re: Timely Filing for Patient?
« Reply #10 on: December 05, 2009, 10:30:04 AM »
Quote
My question was not about the laws with timely fiing with the carriers.  Their previous biller screwed up and did not get them in. I have tried to still submit and ask for exceptions etc. But my question was what is the laws (where do I find them) on sending bills to patients for these?  When is it too late to send the bill as patient responsibility to them?  And I see that some are saying if we are past timely filing with the carrier and provider is in network then it is against the contract to bill the patient?

ahh ok, I see. Ok Assuming like Steve mentioned that the carrier honored the proper and legal timely filing guidelines, and indeed the claim was late and appealed and indeed is patient responsibility.. you can bill the patient..HOWEVER just to be sure I would look into your state's "statute of limitations" on medical bills. In 2000 I had a car accident in NJ, all my charges were covered through Prudential, one of the doctors in the hospital never sent in his bill until 2002, Prudential rejected the claim but in their explanation of benefits it said the doctor could not bill me. So yes you have to check with the policy contract. Last year I had my annual physical and I have 100% coverage (no ded no copay) for annuals, my doctor never sent in the bill until 6 months later and the carrier rejected it. The EOB said "Patient Responsibility: $90" 
Tread carefully because I called my doctor and told him there was no way I was paying for HIS negligence and mistake for not filing this claim on a timely basis. I told him if he insisted I would see him in court. I never got another bill nor did I get sent to collections. IMO if claims are being denied as timely filing you need to be very careful about billing the patient because again.. it's the billing offices mistake and you will get angry phone calls. And if you have a few of these or it's something that's a problem in the office you might want to take a look at what is going on and why these claims are late in being filed and correct that problem so that you are not faced with this dilemma.
Linda Walker
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Steve Verno CMBS, CEMCS

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Re: Timely Filing for Patient?
« Reply #11 on: December 05, 2009, 01:01:20 PM »
A couple of days ago, we got a call from a very angry man.  He was seen in 2001.  He wants to refinance his home.  His loan is being denied.  He has an entry on his credit report about our bill.  he says he was injured at work.  I called and listened to 15 minutes of vile and foul language with threats of lawsuits.  I explained that
1.  There is no documentation in the chart that he was injured at work.
2.  There is no documentation recorded with the State that he was injured at work.
3.  If he was injured at work, he never called us when he was being billed.  He never inforrmed the collection agency via their letters and calls that he was injured at work.
4.  I spoke with his employer.  He never reported the injury, hence no report.

The man accuses us of screwing things up and says this is all our fault.

The State office and his lawyer called yesterday. The lawyer says he will sue me if we dont remove his account from collections.  The state ordered me to remove his account from collections.  I asked if they have a first report of injury on file as per FS 440-13 and FAC 69L-7.602.  They dont.  AT 4pm, the insurance company calls, they were just provided with a First Report of Injury.  They asked me to fax them a claim and they would pay it.  The lawyer, patient, and State all accused me of malfeasance. BUT, the bottom line is the patient was at fault.  He never reported the injury, which caused the employer not to fil a eport causing the insurance not able to process any claims.  His lawyer backed off when I threatened to countersue. 

Welcome to the wonderful world of medical billing.     
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You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
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Pay_My_Claims

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Re: Timely Filing for Patient?
« Reply #12 on: December 05, 2009, 03:55:10 PM »
A couple of days ago, we got a call from a very angry man.  He was seen in 2001.  He wants to refinance his home.  His loan is being denied.  He has an entry on his credit report about our bill.  he says he was injured at work.  I called and listened to 15 minutes of vile and foul language with threats of lawsuits.  I explained that
1.  There is no documentation in the chart that he was injured at work.
2.  There is no documentation recorded with the State that he was injured at work.
3.  If he was injured at work, he never called us when he was being billed.  He never inforrmed the collection agency via their letters and calls that he was injured at work.
4.  I spoke with his employer.  He never reported the injury, hence no report.

The man accuses us of screwing things up and says this is all our fault.

The State office and his lawyer called yesterday. The lawyer says he will sue me if we dont remove his account from collections.  The state ordered me to remove his account from collections.  I asked if they have a first report of injury on file as per FS 440-13 and FAC 69L-7.602.  They dont.  AT 4pm, the insurance company calls, they were just provided with a First Report of Injury.  They asked me to fax them a claim and they would pay it.  The lawyer, patient, and State all accused me of malfeasance. BUT, the bottom line is the patient was at fault.  He never reported the injury, which caused the employer not to fil a eport causing the insurance not able to process any claims.  His lawyer backed off when I threatened to countersue. 

Welcome to the wonderful world of medical billing.     

That is the weirdest thing I ever heard... Most OJI's the employer sends paperwork  with the patient.

Steve Verno CMBS, CEMCS

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Re: Timely Filing for Patient?
« Reply #13 on: December 05, 2009, 08:07:07 PM »
Florida is an interesting place.  Many employers dont like the paperwork and they dont like reporting injuries.  It increases their premiums.  It also brings in OSHA.  About 80% of the employers I deal with say, send me the claim and Ill pay the bill.  You send the claim, they dont pay.   Most of the employers who do this are the tourist hotels, restaurants, and grocery stores.

We have one large store who has a policy that their employees seek treatment via their HMO.  The employee gets injured at 2am on a Saurday and goes to the emergency room.  The claim is denied for going out of network.  This places the bill in the hands of the employee.  Believe it or not, this is allowed under Florida Statute 440.  The patient goes to collections and has to resolve the bill in court in a lawsuit against the store.   Ive fought this with the State and lost.  The State says the store is allowed to do this.  They have permission to be self funded. 
I'l have a double chubby chuck, a mexicali chilibarb, and two cherry cokes
Left hand Blue, Right Leg Green
You got your peanut butter on my milk chocolate.
Dont cut the blue wire! 
I love spam.