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New client - very old A/R

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aboudreau:
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:
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!

aboudreau:
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:
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.

aboudreau:
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

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