Wiki Past timely filing and patient payments

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june616

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It has always been my understanding that if a claim denies for past timely filing, then the payment made by the patient at the time of the appointment should be returned to them as a refund or a credit on their account. The company I work for states that I need to correct my write-offs and remove the patient credits. This is because the office is required to collect the copay from the patient so even though they can't get paid by the insurance, they should still keep the patient payment. Please let me know which way is correct. :confused::confused::confused: Thank you.
 
The payment the patient made at time of service, co-pay, should not be returned as a refund. The patient did receive service that day. Therefore, a co-pay was appropriately collected. It is up to the provider/staff to submit the claim to the insurance in a timely manner for reimbursement of that visit.
 
Ok, thank you very much. I just started here and am having to do a lot of clean up and needed some clarification on this issue. I've learned a lot of new things coming from my old job to this new one :)
 
Patient copay

If a claim is denied timely, then the payor has not apply the copayment and this must reflect on the EOB, they essentially are not allowing anything for the visit. If the insurance company did not allow the visit, they did not apply the copay to that visit. Therefore you should check with the payor on how to apply the copay it could be a conflict. Also timely file can be appealed as long as you can provide proof of timely file. I agree the copay is due but if the insurance company didn't process the claim allowing the copay you may have an issue.
Either check with the payor or your state regulation on refunds. Your EOB tells you if a copay was applied to the visit, and if it was denied timely they are telling you to w/o the visit entirely and not allowing a copay. So, the only way you can apply the copay is getting the insurance to recognize the visit. Otherwise you could be violating your contract with your payor.
Just a word of caution.
 
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