Optometry Coding & Billing Alert

Question: Is there a time limit on when you can bill a patient for their balance due after the insurance company processes the claim? For example, if the patient still owes a balance (according to insurance's allowed charges) after two or three years, are we able to still bill the patient?

Colorado Subscriber

Answer:  There is no national regulation that limits when you can bill a patient. You should check your state's laws, however, to ensure there is nothing specific to your area that places a time limit on when you can bill a patient. You should also check your payer contracts to be sure there is no stipulation you have agreed to by signing as a participating provider.

Keep in mind: Just because there is no time limit, that doesn't mean billing a patient for the first time three years after she had a procedure or service is the best thing to do. If you upset a patient by billing her for the first time a long time after the service -- which likely meant she believed she didn't owe anything because you had not sent a billing statement -- you may lose a patient and will likely have difficulty collecting the fee.

Remember that an unhappy ex-patient is apt to tell anyone who will listen that your practice is bad news. She may even complain to the state medical board and get you investigated for your business practices, warns Barbara J. Cobuzzi, MBA, CPC, CENTC, CPCH, CPCP, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. You should consider the public relations effect of billing three years after a service.

"The doctor is entitled to their money, but it is not fair to the patient to be a lousy business person and they are tempting fate when they bill in this way, in my opinion and experience," Cobuzzi says.