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Patient Balance Time Limit?

Tanya Posted Tue 10th of January, 2012 22:28:18 PM

Is there a time frame to be allowed to bill a patient for their balance due after the insurance company processes the claim? Say after two-three years, if the patient still owes a balance(according to insurance's allowed charges) are we be able to still bill the patient?

SuperCoder Answered Wed 11th of January, 2012 19:36:37 PM

Hi Tanya.
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I am looking into this for you and will get back to you just as soon as I can. I want to do a bit of research before giving an answer.
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Thanks,
Leesa
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Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions
Home office: (866) 458-2973
Email: leesai@codinginstitute.com
www.codinginstitute.com

SuperCoder Answered Thu 12th of January, 2012 13:25:27 PM

Hi Tanya.
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I wanted to check with a colleague to be sure my initial thoughts were correct and she confirmed my thinking. The only issue you might run into is if your state has any laws preventing this. You should check on state regs but otherwise, we think you'd be okay to bill the patient at any point.
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That said, we both agree that if the patient has never been billed for the service before (as in, you're billing them for the first time 2-3 years after the service) that's not the best PR move and you're not likely going to get paid. My colleague agrees. Here's what she said:
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"BUT if you get a patient really ticked off by billing them for the first time a long time after the service, leaving them to think that they don’t owe you because they had not received a statement since the service, and it had been a long time, to quote the person who asked the question, “Say after two-three years”, you will probably run into a very unhappy EX-patient who tells everyone how bad your office is and who may complain to the state medical board and who may get you investigated for your business practices. I have seen this happen with a doctor who set his fees where he wanted to set them and balance billed patients in a non par situation which he had every right to do, but the amount he expected them to pay was so much more than the insurance allowed amounts for R&C that complaints were made to the state medical board and he was audited and it was found that he made coding errors and then he had legal problems. The doctor is entitled to their money, but it is not fair to the patient to be a lousy business person and they are tempting fate when they bill in this way, IMHO and experience.
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And an unhappy patient tells 10 people who tells 10 people who tells 10 people, etc. That is not a great marketing plan."
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Thanks,
Leesa
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Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions
Home office: (866) 458-2973
Email: leesai@codinginstitute.com
http://www.codinginstitute.com

Tanya Posted Wed 18th of January, 2012 22:26:21 PM

Thank you for your response. In this case, it was not the patient's initial receipt of the bill. He has been receiving it for quite some time, and is now fighting back stating he is a lawyer, and since the charges are so old we are legally obligated to adjust this. I did not think this to be right... That would say that a patient can just sit on a bill until the two years are up, which would not make any sense. Why would any patient pay there balance if that be the case? Thank you for confirming my conclusion. You guys rock.

SuperCoder Answered Wed 18th of January, 2012 23:07:03 PM

Wow. That is odd, Tanya.
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I agree that it makes no sense that the patient has received statements and just because he has refused to pay you in those two years you are forced to write it off. If that loophole existed I would think everyone would just sit on their bills for years! :-)
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That said, I would suggest you might want to consult your practice's attorney if the patient continues to bring up legal defense. I assume you have records of when statements were sent out and such. Do you use a collections agency? Perhaps they could offer advice specific to your state's laws as well?
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My one caveat again is that I don't know where you are located and don't know your state specific laws, so there may be some loophole somewhere in your state laws. Again, that's why I'd suggest asking a local attorney.

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Best of luck!
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~Leesa
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Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions
Home office: (866) 458-2973
Email: leesai@codinginstitute.com
www.codinginstitute.com

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