Timeliness Adjustment

[MDO VN]

Hi Michele,

I have some questions about timeliness and code PABD: Physician Adjustment Bad Debt

1. Primary Carrier paid but Secondary wasn't billed yet and it's over one year since that reimbursement. Now balance = 10$ ($6.8 is Secondary part and $3.2 is copayment). If adjust as PABD (due to timeliness), can I leave $3.2 for patient?

2. If in that balance, there is one part of deductible, should we adjust all or leave that part to patient ?

Thanks and have a nice weekend!
Kristy

[Michele]

Hi,
   It is my understanding that you can bill the patient for the part that they would be responsible for, but you cannot bill them for any portion that the insurance company would have paid if the claim had been submitted timely.  That includes deductible amounts.  If the secondary would have picked up the deductible amount then you cannot bill the patient.

Michele

[MDO VN]

Hi Michele,

I will call carrier to confirm their parts before billing patient. Thank you. I have some more questions, could you please help?

1, 1' paid then bill 2', but 2' denied bcs of non coverage, we'll bill pt the balance, is that right? (for example: as per TRIC, pt's not eligible in DEERS)

2, if MED is 1', UHC is 2'. MED paid but failed to crossover to UHC, should we bill patient or resubmit to UHC with EOB of MED 1'

3, If 1' paid, bill 2' many times but no cl received (even I confirmed with carrier the billing address and everything), now It's over one year, should I adjust as timeliness?

Best regards,
Kristy

[Michele]

Hi Kristy,

1.  Yes, bill the patient since they do not have an active secondary.  They are responsible.

2.  Yes, bill UHC with copy of MCR EOB.  Not all claims cross over and you must send them manually if they don't.

3.  You need to call the 2ndary and ask (demand) that they let you fax the claim over.  It is ridiculous that you have sent it multiple times over a 1 yr period.  Ask for a supervisor if you need to and attach proof of the times the claim was submitted.  It isn't the patient's fault that the insurance carrier is terrible.  I would push the insurance carrier.

Thanks
Michele

[MDO VN]

I'm so happy when receiving your responses. I feel more confident to complete my tasks. Pls forgive me if I asked too many
Thanks so much,
Kristy