How long is too long?

khristinelouise

Networker
Messages
34
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0
I am new to the industry and am hoping someone out there can give me some guidance. The clinic where I work has a provider who is way behind on completing her notes and closing her encounters out. Some of her encounters are up to a year old. Now she is leaving so she is finally closing them and my boss wants me to bill them. Is this legal/ethical? I have done a lot of research and been unable to get any kind of an answer. I am very concerned about doing something that might get me into trouble. I would appreciate any advice-
 

Kgourgues

Contributor
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12
Location
Baton Rouge, LA
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Depends on the insurance you are billing to and their timely filing limits. Legally will it get you in trouble, I don't believe so. Ethically, it is not your fault since you are new. Word of advice, don't let it happen on your watch ;)
 

Cheezum51

Expert
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283
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It's carrier specific but most insurers will allow up to a year after the date of service to file a claim. The provider you refer to obviously wasn't being paid based upon her production and collected billings. I wonder how much in lost fees she will cost your office, especially now that she's leaving and may not be available to answer any questions to help with the coding and billing process?

Thomas Cheezum, O.D., CPC
 

sarame

Guest
Messages
28
Location
Lancaster County
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timely filing

Some commercial carriers allow only 90 days for claim submission. You may have some appeals ahead of you, although I am not sure on what basis. I have been very lucky with timely filing appeals when a patient has been non-compliant. However, you should always try. Seems like you are taking on a lot, good luck!
 
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