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blhoffman:
The company I am working for currently has billing consultants in (they were here before I started). Now this company had one biller originally who had this place a mess. After they let her go when their A/R was 5 million in the whole, they hired the consultants. They hired 4 people for billing and collecting, trying to clear up the mess. This is all great.

But I had a request from them to bill a claim that was past timely, to the primary to get a new dated remit to bill the secondary. Now I had already reviewed the claim, the timesheet, the auth., the units, the code billed and billed amount to fee schedule. This was a clean claim. Clean. I refused because my name would be on that claim and I would be held accountable for my part. I cannot say my boss made me do it and be off scott free. Doesn't happen that way. So I said no and why. She didn't push the issue but it has been unpleaseant ever since.

I explained that I cannot rebill clean claims just to get a new remit. The claim would most likely deny for timely and it is in the fraud and abuse guidelines that we cannot do it for this reason. No valid changes - no billing. She became angry with me and since then it has been a hard enviroment for over half a year. This one consultant has even thrown files down on my desk in front of my face, on my hands while I was typing and working another account. Right on top of the file I currently have open. Has anyone else had this problem?

Pay_My_Claims:
Well according to previous posts  you might get an adjustor who is having a good day and get the claim paid :-)

DMK:
Love you Charlene!  Maybe she could slip the consultant a Midol and rub her shoulders for a minute, and say "thought you might be having a bad day and could use this"?

blhoffman:
Last week, same consultant told another biller to remove one unit from the claim to rebill for a new dated remit to bill the Secondary. Another timely issue. We did the service, claim was clean. She wants a new remit. Biller told her no, not unless it was justified.

I had a write off for timely and was questioned on it. Claim was truly untimely and I researched everything but it was our error and I had nothing to appeal. Consultant told me we had 180 days to bill and it was timely. I calmly explained that we had 180 days for initial billing but only 90 days for corrections. She said all billing is 180 days. I explained that is not what the timely filing guidelines say. She called another biller and asked if they had a copy of timely guidelines and was told no. I advised I had it saved to my desk top. I printed it and highlighted the area and brought it back to the consultant. She read it and without looking at me said I could go back to my seat.

At that point I had been working there 11 days. She had been working for the company 9 months and this is our biggest payer, usually $900,000 or more a month. I left there wondering what is going on. Why did a company hired to fix the billing and collect the money, after 9 months, not know the timely filing guidelines for our biggest - nearly primary payer?

Pay_My_Claims:
B, What is the issue about filing the claim??  I have in all seriousness gotten timely filing overturned. I have filed to NC Medicaid claims that were 2 years old, and our timely filing is 1 year. It all depends on the circumstances. I know we don't and CAN'T file medicare just to receive a denial (DME when client isn't eligible for services), but if the claim is payable, and the only issue is that the claim was never filed (or was it). What is the opposition if its not "ilegal" to file past the deadline??? If it is in your contract that you must file within 60 days, and you don't does it mean you CAN'T file. or does it mean, they WON'T pay??

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