Myth Busting: Can You Really Back Bill on Claims?

If you’ve ever found yourself wondering whether you can back-bill for past claims, you’re not alone. At CareTime, we get this question a lot.

Many agencies find themselves in a situation where they’ve missed claim deadlines or submitted claims incorrectly, only to realize later that they’re not getting paid. Naturally, they start looking for solutions—and that’s when back billing comes up.

So, what’s the real deal? Can claims be back-billed? Let’s set the record straight.

The Hard Truth About Back Billing

The reality is that in most cases, back billing simply isn’t a viable option. While some companies may claim they can do it, the success rate is incredibly low. Here’s why:

1. Timely Filing Limits

Most Managed Care Organizations (MCOs) and payers have strict timely filing deadlines, typically ranging from 6 to 12 months. Additional contract negotiations directly with a payer MAY allow an opportunity to waive timely filing if you have a valid exception reason (not knowing payer guidelines is not a valid reason).  This is a one-time allowance typically.

2. Low Reimbursement Rates

Even if you manage to submit within the timely filing limits, the odds of getting a meaningful reimbursement are slim. On average, back billing attempts result in only 2-5% of the original claim amount being paid out. After factoring in processing fees (which can be 5% or more with some services), agencies often end up with little to no financial gain—or worse, a loss.

3. System Limitations & Compliance Risks

At CareTime, we cannot pull billing data from another system. For back billing to even be considered, all billing would have to be manually re-entered into our platform—an extremely time-consuming and error-prone process. Additionally, excessive manual edits can raise red flags with Medicaid, increasing the risk of audits and even potential loss of certification.

Why Back Billing is Rarely Successful

Many agencies assume that back billing is just about resubmitting a claim. But the reality is much more complex.

• We have no insight into how the claims were originally submitted or what went wrong.
• Successfully appealing a denied claim requires an in-depth understanding of operations, documentation, and payer requirements.
• If claims were originally submitted incorrectly, it means critical steps were missed. Trying to retroactively correct them without a full audit is nearly impossible.

More importantly, offering back billing services puts both agencies and billing providers at risk. If an agency didn’t follow the correct claim submission process in the first place, attempting to back bill could lead to compliance violations. It also creates a liability issue—if things still don’t get paid, the agency may turn around and blame the billing provider.

What You Can Do Instead

Rather than focusing on fixing old claims, the smartest approach is to prevent billing issues before they happen. That’s where we come in.

•  98% first-time claim approval rate – Our billing team ensures claims are correct the first time, reducing denials and delays.
• Compliance & best practices – We help agencies submit claims in full compliance with payer guidelines, eliminating the risk of missed payments.

At the end of the day, back billing isn’t the solution—proactive billing is. Let’s make sure you never find yourself in this situation again.

If you want to improve your claims process and maximize reimbursements moving forward, let’s talk. CareTime is here to help.