Practice Management Alert

If you've had a claim denied by a commercial insurer for untimely filing but you filed "late" because the patient failed to give you insurance information in a timely fashion, you may be able to avoid writing off the claim by billing the patient.
 
By proving to insurers that the patient failed to supply insurance information in a timely fashion, Sarah F. Mountford, BA, CPC, accounts receivable coordinator for Physicians Business Network, a billing service for 34 physician groups based in Overland Park, Kan., says she has convinced companies to allow the charge as a patient responsibility.
 
Mountford's computer system tracks every insurance change, allowing her to easily find out the date when the patient provided information. "If a patient calls and changes their insurance, or we get a copy of a new card, we can note it and track the date that it occurred. This way, we can prove to the insurer that the patient called, for example, on Jan. 1, 2002, and the service was on Oct. 1, 2001," she explains.

Send the Insurer a Letter, Proof
 
 
Armed with her proof, she sends a letter to the insurer with a print-out of the insurance message screen attached. The letter asks the insurer 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. It also states that the practice is billing the patient for the services provided. 
 
"I usually don't hear back from the insurer," Mountford says. "I'll send them the letter and the proof, go ahead and bill the patient, and that's it. Rarely, if the patient gets somebody at the insurance company upset enough to have the provider representative call us, we explain the situation, fax them the proof, and they say it's OK to bill the patient." Talking to insurer's customer representatives will do no good in getting the claim moved to patient responsibility. "Customer-service people will simply say no, you can't do that." She says, "Talk to the provider representative. Tell the rep you can prove when the patient gave the insurance information and it was not within the timely-filing period, and the denial is not your fault."
 
Patients are notified of their responsibility through their statements. The patient's account is messaged so the statement shows that the services were denied by the insurer for timely filing, the patient did not provide insurance in a timely fashion, and the claim is the patient's responsibility. "With our computer system, everyone gets three statements and the message would appear on all the statements. So, a patient has 90 days to appeal to the insurer or pay the bill. If it's not paid, it goes to collection," Mountford says.
 
She says that patients often eventually pay. "This holds the patient accountable and demonstrates to them that they truly must give their insurance information."

If your practice lacks a computer system that can track insurance changes, Mountford recommends checking the patient's insurance card at every visit and making a copy of any new card, dating it, and adding it to the patient's chart as part of the permanent medical record. If the patient calls with new information, make a note, date it, and put it in the chart, she continues. The dated copy will prove when the patient notified you of the insurance information.
 
If your computer system is unable to print messages on the patient's statement indicating untimely insurance information, Mountford suggests writing a letter to the patient stating: "Because you did not provide your insurance information until X date, your insurance company has denied the claim and now it is your responsibility. Your options are to send us payment today or appeal to your insurance company."
 
When a patient's failure to supply information causes a claim to be denied for untimely filing, Mountford argues with commercial insurers, including HMOs and PPOs, to have the denials overturned. She explains that the denial was caused by the patient, not the practice. "We have some pretty strict timely-filing requirements with some insurance companies," she says. "I've gotten them to back off and let me bill the patient." Because Medicare's timely-filing deadline is within 12 months of the date of service and it allows six months to file a claim after receiving a denial from another insurer, timely-filing problems resulting from a patient's failure to supply information is not an issue with this payer.
 
Before you attempt billing the patient, check your contract with the insurer, advises Catherine A. Brink, CMM, PCP, president of Healthcare Resource Management Inc. in Spring Lake, N.J.
 
If your contract specifically prohibits billing a patient for a claim denied for timely filing because of the patient's failure to supply information, you may have no option but to write off the charges. If your contract doesn't ban Mountford's strategy, then it may be worth giving it a try.