Filing health insurance claims after time limit expired

[suewoody]

What is the name of your state? Minnesota
I just started working in a chiropractors office. The Dr wants me to send bills to the patients even though the time limit has expired for filing the claims to insurance. I know this is illegal, what kind of punishment would the Dr get if I did that.

 

[JETX]

The Dr wants me to send bills to the patients even though the time limit has expired for filing the claims to insurance. I know this is illegal, what kind of punishment would the Dr get if I did that.

Sending a bill, time limit 'tolling' or not, is NOT illegal. So, either follow your instructions or quit or be fired (for trying to be an attorney!!).

 

[cbg]

Agreed. There is nothing whatsoever illegal about this and the doctor cannot get into any kind of trouble at all for doing so. You, on the other hand, can get into a great deal of trouble with your employer, including losing your job, if you refuse. So you might want to rethink your stance.

 

[suewoody]

The problem is that the claim was never filed with insurance. We have claims that are 2-3-4 years old and were never filed. We filed and got an EOB stating that the time limit had expired for filing therefore we cannot bill the patient. Many of these claims are from Medicare and Medicaid.

 

[cbg]

All that means is that the insurance is no longer responsible. It does NOT mean that you cannot send a bill to the patient.

 

[MellowCat]

What is the name of your state? Minnesota
I just started working in a chiropractors office. The Dr wants me to send bills to the patients even though the time limit has expired for filing the claims to insurance. I know this is illegal, what kind of punishment would the Dr get if I did that.

I disagree somewhat with the previous respondents.

If your office agreed to file the claims to the patients' carriers at the time of service but didn't file on time, then you might face consequences with your contract with Medicare. I've been doing insurance billing for doctors for 7 years now (keep in mind this is Texas, your state may differ). If we don't file our claims on time, our contract with Medicare stipulates we may not bill the patient. This is also true of most commercial carriers. We have to eat that money and consequently, we make darn sure to file our claims timely. Medicaid is different. As long as you have never tried to file a claim w/Medicaid, then there is nothing preventing you from billing the patient. Once you file a claim to them, though, and it's untimely, you cannot bill the patient - so don't even try - just keep billing that patient (good luck collecting, tho).

Having said all that, go ahead and bill the patients per your boss' wishes - I wouldn't sweat it too much. All Medicare can do is get wind of it from an angry patient, then they will likely contact you and tell you to stop billing the patient or face dropping your contract. Then you can see what your boss wants to do.

 

[cbg]

Okay, I'll grant you that my experience with Medicare is minimal. However, my experience with private or group sponsored insurance is very far from being minimal, and for those claims that are not with Medicare but are with private insurance companies, I say again that billing the patient is NOT illegal. Repeat, NOT ILLEGAL. It may or may not violate any contract that the physician has with the insurance company; that will be claim and situation specific. But NO LAWS ARE BEING VIOLATED.

 

[MellowCat]

Okay, I'll grant you that my experience with Medicare is minimal. However, my experience with private or group sponsored insurance is very far from being minimal, and for those claims that are not with Medicare but are with private insurance companies, I say again that billing the patient is NOT illegal. Repeat, NOT ILLEGAL. It may or may not violate any contract that the physician has with the insurance company; that will be claim and situation specific. But NO LAWS ARE BEING VIOLATED.

You are right. The doctor isn't breaking any law and certainly wouldn't face any criminal prosecution. My point was really in reference to "getting in trouble" with Medicare (primarily). I know I wouldn't want Medicare breathing down my neck if I were the doctor. I will also say I've gotten a lot of calls from very riled up private carriers accusing our office of billing patients, not illegally, but "against the rules of the contract." Incidentally, they are always in the wrong after they gather the facts, but they tend to make you feel like a criminal until the facts are presented to them. It was a good call to point out to the poster there is a difference between breaking the rules of a provider contract with the carrier and actually breaking the law. Happily, no jail time for the doctor. LOL.