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Answer: Check your insurer contracts. If you fail to submit the claim in the timely filing period, and you have no provision in your contract stating that the payer will accept the claim if you produce proof of a denial from another carrier, you will have to write off the charges.
Practices can lose thousands of dollars by not meeting timely filing requirements. A typical example involves a patient who is referred to you upon hospital admission, such as through the emergency room. If you perform surgery on an emergency patient, you may not see the patient in your office for follow-up for three weeks. Until that visit, you have not evaluated that patient's insurance status or gathered insurance information yourself. Unfortunately, hospitals frequently obtain inaccurate insurance information, and it's not until you see the patient in your office postoperatively that you discover you have the wrong insurance company. By the time you determine the patient's correct insurance information, you may have filed a claim with the wrong insurer, and missed the timely filing period for the correct insurer. Unless the correct insurer accepts the denial from the wrong carrier as proof of timely filing, you will have to write off the charges.
To avoid this problem, make sure you know what your timely filing limits are. You should bill Medicare within 12 months of the date of service. Payment for assigned services that are not filed within one year of the date of service is reduced by 10 percent, according to the Medicare Carriers Manual. Medicare allows six months to file a claim after receiving a denial from another insurer.
Private insurers you do not contract with usually allow you to submit a claim up to a year from the date of service. Private insurance companies, HMOs and PPOs you contract with will have language in your contract regarding what constitutes a timely filing, and the time period will vary by payer. Some contracts stipulate you must file as soon as 30 days from the date of service, while others more typically allow 60 or 90 days. When you negotiate your contract with a payer, try to obtain a provision that allows you to submit a claim after the time period if you have a denial from another insurer.
Another solution is to preregister your patients. When a patient calls to make an initial appointment, ask for insurance information. Then, verify that information before the appointment. If the physician treats a patient in the hospital, but has not seen the person in the office before, verifying insurance information before the first visit may help you catch a bill sent to the wrong insurance company. And, because patients frequently change insurance companies, asking them to produce their insurance card when checking in for every visit can help your practice maintain current information. Although patients may complain about repeated requests for insurance information, if you explain to them that insurance coverage does change frequently and checking it during every visit can prevent them from being billed, they will cooperate. |
