Medical Billing Forum

General Category => General Questions => Topic started by: dmp001 on April 24, 2013, 10:04:23 AM

Title: untimely filing
Post by: dmp001 on April 24, 2013, 10:04:23 AM
Hello, my question is, if we have untimely claims that are now past the time limit per our contracted timely filing limit, are we obligated to still file the claim so that we can receive the denial?  Or can we just write-off the claim? 

Thanks much!

Title: Re: untimely filing
Post by: PMRNC on April 24, 2013, 11:12:48 AM
Not sure if your "obligated" per se, but you won't be able to bill the patient and why wouldn't you at least take the chance. If you have a lot of claims within a specific time period you can call the carrier and ask them if you can submit them to a single claims person for review along with a small letter indicating why they are late, sometimes the carrier will make an exception depending on many things. I will always attempt. In order to write off you have to make the attempt anyway.
Title: Re: untimely filing
Post by: dmp001 on April 24, 2013, 11:28:07 AM
Thank you for responding.  I only ask because we have a TON of old claims that we know are untimely, especially with Medicare and Medicaid.  The aging is being worked with 2-3 year old claims sitting on them.  Most are claims that we received denials from the Ins, however, someone didn't work the denial in a timely manner and are now untimely for filing to the correct insurances.  My thought was, is it really necessary to receive the denial and have someone else revisit the same claim that's going to be a w/o when the person that worked the aging could have w/o at the time of the follow-up?  I feel it's unnecessary work and I was really wondering if, by law, we still need to file the claim just to receive a true denial??    Does anyone else have this issue and if so, how is it handled within another billing environment?

Thanks much again!
Title: Re: untimely filing
Post by: PMRNC on April 24, 2013, 12:06:18 PM
I couldn't tell you on a blanket basis what to do, but I can tell you there will be a difference if the denials you have are for something the office did wrong, incorrect coding, etc. I can also tell you from having been a claims examiner in a few places that they do keep flags for consistent denials for information and a provider is not consistent with supplying that information. for example, a carrier with a provider in their network who is submitting claims for a particular procedure that is incorrectly coded will have a match in their system every time the same type of claim comes across the system. There are other denials that it's expected the provider file a correction. Denials where it was a patient eligibility, or awaiting info from patient, those can be billed to the patient.

Again, I can't tell you one way or the other, If they were my claims I probably would take the time to go through them and maybe split the work up. For example, let's say you count 100 claims, I would probably try to get 15-20 of them done and gone through a day along with current work so that you don't get behind working on the old.  I would then produce a report for the provider to sign off on the final ones you know you don't have much of a chance of collecting on. J M H O