General Category > General Questions
Over the limit denial. Can biller be held accountable?
kristin:
I am with everyone else in that I think you personally should still try to get the claims paid, by contacting your provider reps for each insurance involved(hopefully it is only one insurance, that will make it easier), and explaining the situation, to see if they will let you file anyways.
There was a time when there was no recourse when it came to timely filing, but in the last few years, I have seen some insurances work with providers when situations that are unusual like this happen.
TN Doc:
Thank you all for your feedback. I plan to file an appeal and speak with the provider rep again to see if there is an exception. She is the one that stated there was no appeal process if it was the fault of the provider or biller. I will have my new biller look in to the old claims to see what else is missing.
I have always done my own billing for this very reason, but decided that my time was better spent helping patients. Unfortunately, I have spent more time chasing her, checking over her work and I'm out almost $1,000.
I just needed the feedback from the billers' perspective that she should be responsible and she should not simply shrug it off. She didn't even apologize. She is blaming me because I didn't tell her that there was a 90 day limit, depsite her 30 year history as a biller.
I appreciate the support and feedback!
Michele:
I am trying to be professional since we are not hearing her side, however it is very difficult! She gives outsourcing a bad name. We file ALL claims given to us within 3 business days of receipt, unless we didn't receive all information needed to file the claim. In that case we notify the provider's office what we need. I believe most billers follow a similar policy. It is absolutely INEXCUSABLE for her to try to blame you as the provider for not telling her about a 90 day filing limit. There are so many things wrong with that logic. First of all as a biller she should know the filing limit, and second of all the claims should have been filed once she got all the information REGARDLESS of how long the filing limit was. Who in their right mind would wait until just before a filing limit to file anyway! Oh my GOODNESS! I am so sorry you have had such an unpleasant experience. We are not all that irresponsible.
Michele:
OK, I'm not done yet. Who in their right mind thinks it's ok to make a provider wait 90 days to get payment for their services! Seriously? My providers would have been all over me within 3 weeks of not getting any checks. Providers have bills to pay, families to take care of, etc. That is just so unbelievable. This one belongs in one of our books!
kristin:
Michele, I am equally as aghast as you are about this whole thing. I have never heard of a biller, in house or out, who waits 6 months or even 1 month to file claims. And they all know the timely filing periods for each insurance they are dealing with, because that is one of the most basic things you should know as a biller, as far as I am concerned. Add to that the volume we are talking about here...under $1000. It isn't like she was being asked to bill $100,000 worth of charges. I would guess most of us could bill $1000 worth of charges in less than an hour. We may not have her side of the story, but I just can't see any side that would not make her seem lazy/inept.
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