Ophthalmology and Optometry Coding Alert

Question: One of our patients visited our office for a visit but didn’t have his insurance information with him at the time of service. The timeline filing deadline is approaching and that patient still has not provided us with his insurance information. What route should we take to rectify this?

Codify Subscriber

Answer: If the patient did not provide his insurance information in time for you to meet the timely filing deadline but your practice had the claim ready to send, you may have a few options.

Appeal 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.

Bill the patient. 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. Check with your payer to ensure that this is a viable option under his or her plan.

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