Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 30, 2012 PDF

Question: Is there a time limit on when you can bill a patient for their balance due after the insurance company processes the claim? For example, if the patient still owes a balance (according to insurance's allowed charges) after two or three years, are we able to still bill the patient?

Answer: There is no national regulation that limits when you can bill a patient. You should check your state's laws, however, to ensure there is nothing specific to your area that places a time limit on when you can bill a patient. You should also check your payer contracts to be sure there is no stipulation you have agreed to by signing as a participating provider.

Keep in mind: Just because there is no time limit, that doesn't mean billing a patient for the first time three years after they had a procedure or service is the best thing to do. If you upset a patient by billing them for the first time a long time after the service -- which likely meant they believed they didn't owe anything because you had not sent a billing statement -- you may lose a patient and will likely have difficulty collecting the fee.