Optometry Coding & Billing Alert

Question: Ive landed a job with a practice where no one seems to follow up on unpaid claims. I am finding open claims for 2005-2007 that were sent to insurance, but the practice never received a response. The original claims met the timely filing deadlines. Can I pursue the money, or should it just be written off?

Colorado Subscriber

Answer: The insurance companies accept the payer  claim acceptance reports to the electronic clearing-houses as proof of timely filing. If your practice kept copies of these reports, you can prove that the practice submitted the claims in a timely basis, and you can fight for payment.

Keep in mind: Depending on the clearinghouse that your practice uses, you may be able to ask the clearinghouse for copies of the payer claim acceptance reports for the practice to prove timely filing. If you have access to those reports through the clearinghouse, you wont have to worry whether the practice kept those reports.

However, if neither the practice nor the clearinghouse has copies of the payers acceptance of the claims, you will not be able to prove timely filing, and it will be difficult to prove that your practice did, in fact, file the claims in time.

Hint: Some payers may make a one-time exception for a practice that has had problems with follow-up. There is no harm in asking a provider representative at the payer to work with you in trying to resolve the old accounts receivable, even when you do not have proof of timely filing. You should contact the provider rep, explain the special circumstances, and ask for one-time assistance and a one-time exception.