Payments > Insurance Payments

Late Filing Charge

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MDO VN:
Dear Michele,

I received an EOB of MED with check amount less than provider paid amount, I found out that the difference is the total of late filing charge (under Prov Adj Amt). What should I do in this case? is it Physician Adjustment (PA) or Debit Adjustment (DA) ?

A friend told me that : "you need to check again for which patient and that patient's payment amt will be adjust to withhold amt due to late charge then you can apply your leftover payment as needed".

Could you please help me to get the correct way to post this?

Thank you,
Kristy

Michele:
If you have been charged with a late filing fee you cannot charge the patient for that amount.  You need to adjust it off as a contractual adjustment.  By being a participating provider you agree to follow the rules of the insurance carrier and Medicare and one of the rules is that claims must be submitted in a certain time frame or they are subject to a late filing charge.  This amount must be adjusted off the same as you would adjust off the amount over the allowed amount. 

Unless you have a reason to appeal the late filing, such as the patient had other insurance that was paying prime, and then they determined Medicare should have been prime and went back and retracted the payment.  So you are submitting to Medicare late since the other insurance had been paying as prime.

Michele

MDO VN:
Dear Michele,

One biller confirmed: I debit adjust for late charge for Medicare.  I post it in Transaction entry because it doesn't work when I post it when I'm posting the payments.

My question: the number of Provide paid amount (shows in EOB) is bigger than that of the check amount (received from bank), that means the money I received not enough to post for all patients as EOB shows (the late charge is the difference and the reason).

So if I post all patients, I will lack of some money to post. Pls help me to solve that.

Thank you for your helps,
Kristy

Michele:
On the payments that the late filing penalty was applied, you need to apply the payment - the penalty as the actual paid amount, not the amount that it shows paid on the claim line.  It should show something like:

Code          Billed        Allowed        Adjusted      Paid
99213         60.00       55.00            5.00          44.00

Pt resp  11.00          late filing fee   0.88            43.12


You would enter the $43.12 as paid, adjust off $5.88 and leave patient responsibility of $11

I hope that helps.
Michele

MDO VN:
Thank you for your quick responses, :) I posted correctly as you suggested and it's the simple way to do that. But I would like to share with you another way to post payment with late charge fee (my supervisor instructed me as the important of a paper trail for auditing purposes)

1.) enter the original payment $44
2.) enter the original PA (physician adjustment) of $5
3.) add payment line using DA (debit adjustment) entering the $0.88 (positive). It will appear as patient responsibility ($11.88)
4.) add 'LATEFEE' payment code for the amount of $0.88 (negative) and it will balance out to $11.
5.) Save.

But the unapplied amount will be negative = - 0.88, then we do a takeback, when by doing this, it will bring the negative to zero. This is what a Debit adjustment is. 

How do you think? Pls share your comments if any.

Thanks again,
Kristy

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