Author Topic: past Filing Deadline  (Read 3952 times)

macbook

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past Filing Deadline
« on: April 24, 2012, 03:45:49 AM »
Hello again,

I am starting on operation clean up for a new client with so many past timely filing claims. I recommended to start writing off all the claims that were past the timely filing cut off because it was a lost cause. However, the wife of the Doctor insists we still send out the claims to get an EOB denial then we can write off bec accdg to her "it is the law" and she read it. And she wants us to still try in case it gets paid.

But in my experience, I have never come across such law.  Or even a policy
with the payers. So was wondering now if this hold true? 

I am thinking of standing my ground. ;D

Thanks.

Michele

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Re: past Filing Deadline
« Reply #1 on: April 24, 2012, 06:52:02 AM »
Actually I have a couple questions first.  Weren't the claims previously billed?  If so, isn't there any proof of the previous billing so that the timely filing denials could be appealed?

Anyway, some insurance carrier contracts state that any services to their patients must be filed which is what the dr's wife may be referring to.  But I believe she is misinterpreting the contract.  However, without answers to the above questions I wouldn't want to advise you to just write them off.
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PMRNC

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Re: past Filing Deadline
« Reply #2 on: April 24, 2012, 07:51:59 AM »
I don't ever recommend a client write-off any claim as a lost cause w/out having an EOB so I'm with the wife on that one.  As for it being law, she is misinterpreting it somewhat but she's not that far off the mark, you do have to do what you can to collect balances and out of pockets.   I, like Michele would also have to wonder why there are claims past the timely filing limit, so that whatever the problem is can be corrected and prevented from happening again.
Linda Walker
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macbook

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Re: past Filing Deadline
« Reply #3 on: April 24, 2012, 05:16:19 PM »
Thank you Michelle and Linda.

On this new client, they have been "burned" with the last biller. For some reason the 120 days and over were never billed out. So I know that this would be a waste of our time as well as what they will pay for our time, because of the timely filing deadline. UHC has a timley filing deadline of 90 days as well as Texas Healthspring, Medicaid(TMHP) etc and a couple more thats why we recommended this before we would take them on.

But its good to know that some payers do have it in their contracts that we still have to bill out the claims inspite of the timely filing. I need to look into that.
 :)We do whatever it takes to get the provider paid. But when it comes to timely filing, even the payers tell us its a lost cause when we call them.

PMRNC

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Re: past Filing Deadline
« Reply #4 on: April 25, 2012, 06:08:31 AM »
Quote
On this new client, they have been "burned" with the last biller. For some reason the 120 days and over were never billed out. So I know that this would be a waste of our time as well as what they will pay for our time, because of the timely filing deadline. UHC has a timley filing deadline of 90 days as well as Texas Healthspring, Medicaid(TMHP) etc and a couple more thats why we recommended this before we would take them on.

But its good to know that some payers do have it in their contracts that we still have to bill out the claims inspite of the timely filing. I need to look into that.
 :)We do whatever it takes to get the provider paid. But when it comes to timely filing, even the payers tell us its a lost cause when we call them.

Since you didn't file them you don't HAVE an EOB to really say it's a lost cause. Also In certain situations a letter with all claims attached explaining the late filling can be used as an appeal with a denial and there is still a good chance claims will get paid. Without trying there's no way to say for sure they were "lost causes". I have done late filing appeals with some good success in many situations. I find explaining the situation as a whole and with all the claims shows the provider there was an extenuating circumstance. That's why a claim is never really a "lost cause" until you have a denial and have exhausted appeals when they are warranted.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

macbook

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Re: past Filing Deadline
« Reply #5 on: April 25, 2012, 06:49:43 AM »
Thanks Linda!

Michele

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Re: past Filing Deadline
« Reply #6 on: April 25, 2012, 12:23:58 PM »
I agree with Linda.  I would go to a provider rep if possible to see if you can submit one appeal for all claims.  We have done that in the past and were granted a 1 time exception.  It may be worth a try.
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macbook

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Re: past Filing Deadline
« Reply #7 on: April 26, 2012, 03:15:52 AM »
Thanks so much Michelle!  :)