Wiki Timely Filing / pt negligence

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MFaulkner

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Barren River Kentucky Chapter
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:confused:In my office we have an issue that I am not sure the policy on. We have a lot of patients that we send several statements to with no reply, then of coarse we transfer them to collections and once there either the pt calls them with the insurance information or somehow they come across it. Then we bill the insurance company and they deny for timely filing. Now since we have sent the pt several statements and went through all the correct steps would these bills be pt responsibility since they neglected to give their insurance information while receiving these statements or would we have to write it off for timely? I am just a little confused because to me its a failure on the pt's behalf and should be theirs but i am not sure and does this differ for commercial ins compared to medicare and medicaid. PLEASE HELP :):confused:
 
Your office should verify coverage every time the patient comes in for an appointment. Coverage can change at anytime. Make a copy of their card; front and back. You can call the insurance company to make sure patient still has coverage. Patient's are worried about their illness not their insurance. They know they are covered and are not thinking about it.
 
this pt was seen at the hospital only, so we did not receive the cards. when we got their information from the hospital there was no insurance given. And we sent the patient 8 statements before ever turning them over to collections
 
You can try to appeal to the insurance company stating that wrong info was given at time of service.

I always check Medicare and Medicaid to see if the patient has either of those insurance's but if you have exhausted every avenue to get the correct insurance then it is the pts responsibility.
 
There are a couple of other things you can try. If you have the staff & time, make 1 last ditch phone call to facility for ins info @ about 90 days out to deal with timely filing. It will be extra work at the beginning, but you may find it is worth the trouble and you may see an increase in revenue.

Another little known fact is that patient's can submit a claim to their insurance company on their own. The insurance companies hate this and so do the patients. It takes work but if the patient really wants to get their claim paid, they will go thru the work. All they need is an itemized statement from the provider and then call their ins co to request a claim form. Keep in mind they would have to do this if they were seen out of the country or saw the doctor while on a cruise. It seems silly but I have worked with patients in the past and it truly does work. The payor may even call the provider & request a claim as a courtesy to their policyholder and waive timely filing.

I think sometimes we do have to go above & beyond to provide the best customer service to patients. They are just as lost in the world of insurance companies as we feel.

Hope this helps :)
 
thank you all for you help, It is really appreciated and I will pass that information along to the woman who does collection submission. And that is good to know about the pt submitting the claim i had no idea thank you
 
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