Author Topic: New client - very old A/R  (Read 2431 times)

aboudreau

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New client - very old A/R
« on: August 28, 2012, 04:37:29 PM »
Hi - I just signed on with a new client (my second). She's most concerned with getting old claims paid. The problem is that her previous billers have been, I would say, negligent. I was looking over old EOBs and there were denials for errors that should have been corrected. There are claims going back years that were never resolved.

At this point I'm not sure how many claims were actually submitted - she suspects that many were not.

Questions:
Knowing that Medicare has a one year filing limit, should she just write off everything older than 1 year if it was never submitted?

If a claim was submitted and denied for whatever reason, how long do we get to appeal? I think 120 days from the date of notice, not date of service? So should write off EOBs more than 120 days?

Frankly, I'm overwhelmed and just trying to figure out where to start. Her previous biller has all the information which hopefully will get forwarded to me, otherwise I'll be digging through file cabinets full...

Any help or advice is welcome.

Michele

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Re: New client - very old A/R
« Reply #1 on: August 29, 2012, 07:02:49 AM »
Unless you have proof of the original submissions you have no grounds for appeal.  The problem is that going after this older stuff is a LOT of work so you should be paid more.  It is not 'clean' billing.  Each carrier has their own rules on how long you have to appeal.  Personally I would start with the most recent and work my way back.  You have a better chance of getting payment on the most recent stuff as opposed to the older stuff.  The only problem with that is that you lose more as time goes on, but the older stuff is harder to collect anyway.  Make sure she knows that you are not a miracle worker and you have a pen not a magic wand.  You will do all you can, but what is lost is not your fault.  It's amazing how some will blame the new biller for not being able to appeal and resolve the mistakes from the old biller!

Good luck!
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aboudreau

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Re: New client - very old A/R
« Reply #2 on: August 29, 2012, 09:24:03 AM »
Thank you Michele! I just realized that I put this in the wrong thread.

I do have a number of EOBs, isn't that proof of submission? I know that it's a lot of work, as does she - I think she also recognizes that a lot of it is just lost so anything I can get is frosting. I just want to make sure that I work on them the right way, so the more recent stuff is how I'll go.

Her old billers left about $70K in old claims - considering that she isn't angrier at the old billers (I'm furious just looking through her records!!), I don't think she'll blame me. As long as she sees that I'm trying, anyway.

Thank you! thankyouthankyou. I'm sort of staring around at the stuff she gave with with a glazed look in my eyes - you've been very helpful.

PMRNC

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Re: New client - very old A/R
« Reply #3 on: August 29, 2012, 11:10:14 AM »
I'm a little confused.. you originally said you were not sure what or how many were not submitted, but yet you have EOB's.. yes that counts to show submission but whether they qualify for an appeal is probably what your looking for? that would depend on the EOB's and their denials.
Linda Walker
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aboudreau

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Re: New client - very old A/R
« Reply #4 on: August 29, 2012, 12:54:03 PM »
Sorry, to clarify - there are a number of EOBs with denials, but the provider also believes there are OTHER claims never submitted. For the ones I have EOBs I'd like to appeal, if possible. If never sent, I'd like to submit (if within timely filing). Has anyone ever had success appealing timely filing rules for something like this, where the billers were negligent?

Specifically for Medicare, the ones that allow appeals, I'm wondering if I should even bother to TRY if the notice was more than 120 days past.

I'm still waiting to get info from provider, such as her contracts with carriers so I can see if there's any room there. I guess I'm just looking for general thoughts/feelings.

Thanks!
Adrienne

PMRNC

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Re: New client - very old A/R
« Reply #5 on: August 29, 2012, 01:21:45 PM »
The claims you want to appeal, of course if they are claims that can be appealed you should attempt it. For those never submitted, I always say, what have you got to lose? If you are taking on the project alone of cleaning up A/R I recommend you are reimbursed on an hourly rate rather than a percentage. This way you are reimbursed for the time and work you put in regardless of the outcome. For timely filing, no, billing negligence is never going to fly as an appeal, your best bet is to go with an "oops, we are sorry, we bad, could you please consider the claims"  I used to be a claims examiner and really it depended on the claims, the appeal letter and even if I was having a good day or bad day.. sorry but that's true. Examiners at all carriers have authority and payment threshold's they are allowed to use to make administrative decisions. Late/Timely filing guidelines are include, I can't tell you it will work, can only tell you how I reviewed them when I received them. I first looked to see how many there were, then I look at the appeal letter and then I just make a decision and basically it boils down to whether I think there should be an exception made. Not exactly what we want to hear as billers but still doing nothing insures NO reimbursement so again, what do you have to lose. I can make a suggestion, if you have a LOT of claims totaling a LOT of money, I would call the carrier and see if you can get a specific examiner on the line that will allow you to send them to him/her, document the phone call and include it with your appeal.. this way you give someone there a heads up. Above all be super nice.. you catch more flys with honey than vinegar my mom always said :)  Treat your examiner as you should treat your waitress :) LOL   By calling ahead, you are making a good conscious effort to correct a "mistake" and you are more likely to gain the sympathy and understanding of a good claims specialist by calling ahead.    JMHO.
Linda Walker
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aboudreau

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Re: New client - very old A/R
« Reply #6 on: August 29, 2012, 04:03:57 PM »
Linda, that is very good advice. Would it be a claims rep I try to talk to? Is that the same as an examiner or is there a different department I should be looking for?

Thanks!!

PMRNC

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Re: New client - very old A/R
« Reply #7 on: August 30, 2012, 10:07:40 AM »
It depends on the carrier, with some you have to speak only with customer service and they make the decision to contact the claims department. It also depends on how the carrier is structured. Some examiners simply work on specific employers and some carriers have other means of determining which policies they work on. If I need to speak to a claims rep I usually call the claims line and request to speak with an actual claims specialist. Some will let you and others will not but if the plan does have a specific examiner they will give you their name at the very least. Some carriers will have their customer service lines ring right to the examiners.    There's a few plans I work with who are great and I have a few specific contacts with many of the carriers. Comes in handy :)
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: New client - very old A/R
« Reply #8 on: August 31, 2012, 01:19:41 PM »
We have contacted provider reps in the past and many times they will allow us to submit ALL claims affected at one time with an appeal and they make an exception.  Like Linda said, it's worth a try.
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