Billing > Billing

Primary vs PI (Timely Filing)

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jenfogle:
Will you clarify with regards to the timely filing being patient responsibility?  My experience has been that timely filing denials are provider responsibility.  If the provider is taking the responsibility to bill their pt's insurance, then they are required by contract to submit within timely filing limits.  I don't believe a PI case is any different; the provider should have billed pt's private insurance in order to get the claim on file.  As you stated, they would have either pended or they would have paid the claim and then later go after the attorney for reimbursement.  I really hope I'm not wrong! haha, we've written off many charges after learning the hard way that we should have been billing private ins if it looked like we weren't going to get reimbursed from the PI within timely limits!

PMRNC:
Well, technically BCBS can still deny..the point is it's not an appeal as there was no denial to appeal..You obviously can't go back.. HAD they submitted to BCBS, they (BCBS) would have requested details and sent the provider a ROR letter which would basically say they will pay claims, however if the suit is won they want their money back..That would have been the proper way to handle it from the beginning..but hindsight is 20/20.. it however isn't a lost cause..you never know, it can't really hurt to try.  I don't believe however the provider is out of luck...it's kind of a sticky situation..the patient would have some liability there too..

DMK:
JMO, but it the doctor hadn't been paid already, it must have been a no Med Pay or Third Party Claim and there should have been some sort of "agree to pay" signed by the patient and/or their attorney. 

Our office no longer takes Third Party claims for just this reason.  We just bill the patient's health insurance or they pay the cash rate per visit.  Then let the insurance companies duke it out.  Now, not only is the patient out of luck, the doctor may be too.  Sorry that happened, but sometimes the cases aren't so great.

If it's a Med Pay case, we bill the Med Pay first, then if it runs out (because it's low, or the patient had significant injuries) we then bill their health insurance.

We are finding more and more that the attorneys are insisting that the patient use their health insurance 1st to get the discounted rate. 

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