Payments > Patient Billing

billing timeliness

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kjkrunner:
I am a patient and was sent the first bill for an urgent care appointment 13 months after the date of service.  I find this ridiculous and have heard that if you are not billed within 1 yr of service, patient is not responsible for paying.  Is this true?  How can I prove this or contest with service provider without ruining my credit.  For 2 weeks I had overlapping coverage with two insurance carriers and apparently they were passing it back and forth arguing over who was responsible.  I had no idea until the bill came.
Please advise.  Thank you,
 Kelly

Michele:
Laws vary from state to state so you would have to check, however, I don't know of any state that has a 1 yr law.  But, if you had insurance, and the urgent care place participated with the insurance, then it is their responsibility to get this figured out.  I would call the insurance that you had at the time (or the primary one, if you had two) and ask them if the claim was submitted, and if the urgent care place is in their network.  That is the best place to start.  Depending on the answers, you should have a direction.  If they don't even have the claim, call the urgent care and advise them that they never billed your insurance.  If the claim was denied, why?  Maybe it can be reprocessed.  In any case, call the insurance first.

Good luck
Michele

tlewis:
My understanidin is that the one year law applies to timely filling with the insurance company. Is your bill for the entire amount without insurance adjustment or payment? If it is and they did not bill your insurance you may be correct with the timely filling. If they did not file a claim to your insurance in a timely manner or send in requested information you are not responsible for the bill. If however it took the insurance company a year to finally pay(which unfortunatlly is not unusual) than you are required to pay. Another possiblity is that they Insurance company asked you( the patient ) for additional information and you did not respond, then the balance would be your responsiblity, however you could prob find out and still send in the information and your insurance would pay. Your best bet would be to call your insurance company and find out if a claim was sent, find out if additional info was need and from whom. Also find out if the physicians office was contracted with your insurance and was obligated to bill. Lots of possibilites with this one. Always call your insurance and have them tell you what your payment responsibility is. If they state you do not owe and the phys is sending you a statement. I would have your insurance advocate for you. Thats part of what you pay those high premiums for.

PMRNC:
Timely filing, like Michelle says will depend on state and carrier requirements, there really is no ONE timely filing limit.  Also in regards to patient billing that too would be a statute of limitations issue again determined by the state.

1. As mentioned, call your insurance carrier to find out if they received the claim.
2. If they received the claim and processed, get a copy of the EOB, look at the date the claim was processed.
3. Check your state law/statute of limitations (IMO, a year is too short, your going to find out the statute of limitations can actually be 5 years or more!)
4. If your insurance carrier HAS not received and processed the claim, find out their timely filing and take appropriate steps to notify the facility.  It will also matter if you did not give accurate insurance information at the time of service so keep that in mind.
5. if it's beyond the carriers timely filing limit you can appeal the billing with the provider and again refer to the statue of limitations.

tlewis:
wow I want to work in one of those states. Noridian Medicare just went to 12months for timely filling. Aetna is like 3 months. different plans run anywhere from 6 months to 12 months. I don't have any insurance company's that let me file a claim after 1 year.

Timely filling= clean claim. When I first started working here the person I replaced did NOT know how to bill and did not understand that if the info was wrong it was not considered a clean claim and therefore the insurance company did not have to accept the claim as being filed in a timely manner. I had to write off a ton of money. Fortunatley I was also able to get alot of back claims paid but non over 12 months except for medicare which at the time was 24months
http://www.allsupinc.com/changes-to-medicare-timely-filing-guidelines.aspx

also if an insurance company has asked for additional information ei. OP notes and I do not provide them within 45 days the claim is closed with no payment or pt responsibilty until the OP notes are recieved I'm not even sure how long I have after the 45 day because I have always sent in the additional information.

If you know of something that I am misunderstanding with the Timely filling it would be greatly appreciated as if like you said I can go back 5 years I might be able to get some more money on accounts that I thought were uncollectable  :)

I should add that these are all for insurance carriers that we are in network and required by contract to bill. I also feel that it is my responsibility, when the info the pt gave is accurate, to insure that these claims are processed correctly. I do this everyday and I get confused think how the patients feel. Pt calls the insurance company and says that the procedure was not covered. well turns out it wasn't coved because the biller put in wrong diagnosis code pts fault or Phys. Or how many times I have gotten a bill on a balance I didn't owe. Fortunetly I know how to fix it but the average person is not going to understand.

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