Ophthalmology and Optometry Coding Alert

Question: We just discovered that for the first six months of this year, we have been charging $66.42 for 92014 (comprehensive established patient, one or more visits) when we are allowed to charge $92.99. Must or can we go back and correct the old ones?

Maryland Subscriber

Answer: No, you do not have to send corrected billings. Medicare requires that you do not bill for or collect for more than the approved amount for services, but does not require that you match that approved amount when setting your fees. If you decided you did want to send in corrected billings and be paid the difference, you would want to send the corrected claims into the review department as a batch explaining why you are resubmitting the claims. The review department would need to see the original claim and explanation of benefits (EOB) and the new corrected health insurance claim form. Just remember, though, when the claims are reprocessed for the additional payment, your patients are going to receive a new explanation of benefits also, and have an increased co-payment amount that either they will be responsible for or that they will want you to rebill to their secondary insurance companies.