Anesthesia Coding Alert

Question: Our pain management specialist performed a service for a patient despite the patient not having his insurance information with him during the visit. We’d like to submit the claim and get paid, but the patient still hasn’t given us any details about his insurance. We’re getting close to the timely filing deadline. How should we handle this?

Montana Subscriber

Answer: Timely filing is a legitimate concern, but there is some good news: If you have the claim ready to send but don’t get the patient’s insurance information in time for you to meet the timely filing deadline, you may have a few options.

Choice 1: Start by appealing to the payer. Practices have successfully appealed timely filing denials when the patient did not provide the information until after the filing limit. You can try appealing the denial, explaining that if the patient had provided you with the correct insurance information, you would have filed the claim within the proper amount of time. You may want to include documentation showing when you first billed the patient and a history of all other statements you sent to the patient.

To appeal when the patient delays insurance information, send a letter to your payer and include a printout from your system that shows the insurance information and when the patient gave it to your office. In the letter, ask the payer to rescind its denial based on timely filing and instead deny the claim as the patient’s responsibility because the patient failed to provide insurance information.

If you use an electronic system, you can easily keep track of when patients call in and make changes to their insurance as well as when you get copies of new insurance cards. This documentation will help you prove when the patient gave you her insurance information.

Option 2: Bill the patient directly. The only time you can submit a bill to the patient after the timely filing deadline and successfully seek payment is if the patient did not provide you with the proper information before the filing deadline. The payment then becomes the patient’s responsibility, and you should bill the patient rather than write off the claim amount.

Option 3: Write off the claim. It’s the least desirable option, but if the other two don’t work it may be your only choice.