I have a dr a bit behind on his surgery dictation. Is there anywhere thats specifies an amount of time for dictation? thanks
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The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file appeal requests on a timely basis. A request from the provider, physician, or other supplier to extend the period for filing the request for redetermination would not be routinely granted.
Note: A finding by the contractor that good cause exists for late filing for the redetermination does not mean that the party is then excused from the timely filing rules for the reconsideration.
Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:
• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;
• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (the Centers for Medicare & Medicaid (CMS), the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);
Note: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.
• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;
• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);
• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;
• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;
• A death or serious illness in his or her immediate family; or
• A request was sent to a government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired.
Note: Failure of a billing company or other consultant (that the provider, physician, or other supplier has retained) to timely submit appeals or other information is not grounds for finding good cause for late filing. Also, good cause does not exist where the provider, physician, or other supplier claims that lack of business office management skills or expertise caused the late filing.
See also: Time Limits for Each Level of Appeal
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Tag Archives: filing
Timely filing when patient DID NOT update insurance
Howdy 
A patient was originally seen about a year ago and provided no insurance information. They made a couple small payments on the 2 bills over the course of a year. Then, they called almost a full year after originally seen and, "Oh! Here’s my insurance – bill it, please!"
Ugh.
So we did. And they denied it as being wellllllllll past timely. (I’ll give you a minute to get over your shock.)
So… can we bill the patient for this because they DID NOT give us that info timely and we can back that up if need be?
We’re having a differing of opinions here. If you say we can, please provide a link to some sort of reference for this.
Thanks!
Patient Calls with insurance info after filing limit.
If a patient was seen and did not present insurance and was billed for the visit, decides to call with insurance info well after the filing limit for their insurance, are they responsible to pay or do we have to write it off?
Woman convicted for filing false medical claims
Lajuana Scott was sentenced to one year in jail and five years on probation following her conviction of three felony counts of embezzlement from a nonprofit or charitable organization. The former clinic biller made Medicaid claims for services never performed and then used nonprofit money for personal use.
Click here for the full story!
The post Woman convicted for filing false medical claims appeared first on The Coding Network.
timely filing
question: Pt claimed auto accident with attorney representation 08/16. Attorney refused to represent pt. Is it too late to file to Medicare?
Sharon
Copays for visits denied for timely filing
If a copay was collected for an office visit but the visit was never billed to insurance or the claim denied for timely filing, is the provider allowed to keep the copay? Technically an allowed amount was never adjudicated by the insurance company, so would it be wrong to keep the copay?
Timely Filing Issue
Wondering if anyone would be able to help or has recommendation for this scenario.
I was off on a medical leave for 6 mos and when I returned come to find out none of the billing was done have been catching up but getting denials for those 90 days Timely filing issues. Is there some type of forgiveness letter or suggestions anyone might have one how to appeal these denials some are the FHP/ICP or MMAI products others are Aetna Cigna etc.
Thanks
Barb
I was off on a medical leave for 6 mos and when I returned come to find out none of the billing was done have been catching up but getting denials for those 90 days Timely filing issues. Is there some type of forgiveness letter or suggestions anyone might have one how to appeal these denials some are the FHP/ICP or MMAI products others are Aetna Cigna etc.
Thanks
Barb
Good cause for extension of the time limit for filing appeals
The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file appeal requests on a timely basis. A request from the provider, physician, or other supplier to extend the period for filing the request for redetermination would not be routinely granted.
Note: A finding by the contractor that good cause exists for late filing for the redetermination does not mean that the party is then excused from the timely filing rules for the reconsideration.
Good cause may be found when the record clearly shows, or the beneficiary alleges, that the delay in filing was due to one of the following:
• Circumstances beyond the beneficiary’s control, including mental or physical impairment (e.g., disability, extended illness) or significant communication difficulties;
• Incorrect or incomplete information about the subject claim and/or appeal was furnished by official sources (the Centers for Medicare & Medicaid (CMS), the contractor, or the Social Security Administration) to the beneficiary (e.g., a party is not notified of her appeal rights or a party receives inaccurate information regarding a filing deadline);
Note: Whenever a beneficiary is not notified of his/her appeal rights or of the time limits for filing, good cause must be found.
• Delay resulting from efforts by the beneficiary to secure supporting evidence, where the beneficiary did not realize that the evidence could be submitted after filing the request;
• When destruction of or other damage to the beneficiary’s records was responsible for the delay in filing (e.g., a fire, natural disaster);
• Unusual or unavoidable circumstances, the nature of which demonstrates that the beneficiary could not reasonably be expected to have been aware of the need to file timely;
• Serious illness which prevented the party from contacting the contractor in person, in writing, or through a friend, relative, or other person;
• A death or serious illness in his or her immediate family; or
• A request was sent to a government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired.
Note: Failure of a billing company or other consultant (that the provider, physician, or other supplier has retained) to timely submit appeals or other information is not grounds for finding good cause for late filing. Also, good cause does not exist where the provider, physician, or other supplier claims that lack of business office management skills or expertise caused the late filing.
See also: Time Limits for Each Level of Appeal