General Category > General Questions

Over the limit denial. Can biller be held accountable?

(1/4) > >>

TN Doc:
I have a small practice and hired a new biller, who came highly recommended by a colleague.  Despite numerous inquires as to the status of my claims, she finally submitted them, but they were over the 90 day limit.  There is no appeal process since it was her error.  >:(  She stated that I need to write the $950 off.  I feel that it is only fair that she write it off against my balance that I owe  her. 
Unfortunately we have no contract and I doubt that she has errors and omissions insurance.  Any feedback would be appreciated. Thank you!

Michele:
Wow.  So sorry that you are having such a bad experience.  Unfortunately not all billers do a good job.  You are in a tough spot but here are a couple of suggestions.  First, do you know why the claims were not submitted sooner?  Was there a valid reason that could be used as an appeal?  Did the biller even consider appealing?  If there was a reason that the claims were not submitted in the 90 day time frame the claims might be able to be appealed.  (The appeal must be within a certain time too!)

Second, do you have a provider rep for the insurance carrier that this involves?  If you do, I would contact that provider rep and explain what happened.  You did try to do everything you could to make sure the claims were filed timely but your biller let you down.  It is possible the provider rep will do a one time exception and allow the claims to be processed.  Our local BC will sometimes do this for providers who are in situations similar to yours.

Now as far as her advising you that you need to write off the $950, that does seem unfair.  That was a lot of work provided by you that you won't be reimbursed for.  If the reason was simply she didn't submit them in time then she should be responsible.  However, without a contract I don't know if you can do anything about it.  You could ask her if she has E&O but like you said, doubtful.  I hope you have at least made other arrangements for your billing.

I wish you the best in this situation.  Let us know how you make out.

TN Doc:
Michele,  Thank you for your feedback. 
The biller thought she had a longer deadline, but nonetheless, she shouldn't have held the claims for over 6 months before submitting them.  She checked and there is no appeals process since it was her error.  At this point I have no other choice but to write off this amount against her invoice and write off the balance.  Since there is no contract, I don't see how she could sue me for writing off the payments against her bill.

I was curious what the ethical and legal guidelines for billers are in a situation such as this. I appreciate any feedback.

Michele:
I personally would still try to appeal.  You directly, not the biller.  They will have no sympathy for her, but they may for you.  It's not a guarantee but you never know.  But the part that blows my mind is how could this person hold claims for 6 months?????  Why????  Was there some reason (other than "I thought I had longer")?  Her job is to bill the insurance.  Why would she wait even if she thought she had time?  Not to mention 6 months is actually long, most insurances are 120 days or less!

rdmoore2003:
I agree with Michelle.  You should write a letter and drop the claims to paper and mail them in with the letter attached.   Now, for the biller, she would have found her last paycheck as she was out the door.  As for now, it is $950 that you know about.   It may be worth it for you to get someone to do an audit of your claims.
Depending on your software, you may be able to run a report on services that have not bill filed, however, if your biller has not put the charges in, then this will not work.
Does your biller do in-house billing?

Navigation

[0] Message Index

[#] Next page