Billing > Billing
Timely Filing for Patient?
PMRNC:
--- 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?
--- End quote ---
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.
Steve Verno CMBS, CEMCS:
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.
Pay_My_Claims:
--- Quote from: Coding4aliving on December 05, 2009, 04:01:20 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.
--- End quote ---
That is the weirdest thing I ever heard... Most OJI's the employer sends paperwork with the patient.
Steve Verno CMBS, CEMCS:
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.
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