# What to do with patient balance?



## MonarchMedBill (Sep 11, 2017)

Hi guys!

I work in a physician network for a set of physicians.  One of our physicians did a bariatric consult.  He did not sign/lock the progress notes until 117 days after the DOS.  The insurance is UHC and our contract states timely filing is 95 days.  In our office, this tends to happen often and the protocol is to submit the claim anyway to get the timely filing denial for the patient file.  Now that we have the denial back I need to adjust off the balance.  However, here is my question:

The patient paid $60.00 on the DOS.  The claim billed amount is $620.00 and the balance currently sits at $560.00.  I've never come across a patient balance in this situation.  Are we under an obligation to refund the patient and adjust off the $620.00 billed amount?  Or do we accept the $60.00 as paid in full and adjust off the $560.00 balance?

Thanks in advance!


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## Chelle-Lynn (Sep 11, 2017)

There are a couple of things to consider in this case....

1. Are you contracted with UHC?  If so, if they denied the claim as not a benefit for late filing then yes, I would recommend returning the co-pay to the patient, as per your contract generally you cannot hold the patient liable for the balance.

2. If you are not contracted with UHC then I would look at your internal policies in regards to these scenarios.  Your physician not completing their documentation for over 3 months is a red flag and from a compliance point of view it is definitely a questionable situation.  Your compliance officer should be able to assist you with this situation. 

A good rule of thumb in grey areas is to error on the safe side and not put your practice at risk.  In our office we would return the monies.

For future issues I would use this as a example for your providers as to the financial pitfall not completing their documentation timely can be.  CMS recommends completing documentation the same day and at the longest within a few days.  Overall guidelines stay within a reasonable timeframe.  3 months is not reasonable.


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## MonarchMedBill (Sep 11, 2017)

*Thank you!*



Chelle-Lynn said:


> A good rule of thumb in grey areas is to error on the safe side and not put your practice at risk.  In our office we would return the monies.



Good information and great insight.  


I have only been with the company about a month so I'll have to tread lightly.  I am a CPC, CPB and I just sat for my CPMA yesterday, but I am still so new here, my opinions aren't quite appreciated yet.

My thoughts were that we needed to refund the money, however, I needed information to back it up.  Your comments helped tremendously and I appreciate the suggestions!


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