Optometry Coding & Billing Alert

Published on Sun Dec 26, 2004 PDF

Question: We've just discovered that we have been using the wrong place-of-service code on our claims for the past couple of months. We've corrected the error going forward, but I'm not sure how to handle the claims already sent out and paid under the wrong place of service. Since we've never received a denial, would the fact that we've caught the error and corrected it be sufficient, or do we need to correct and resubmit all the erroneous claims?


Ohio Subscriber

Answer: Despite the fact that your carrier accepted the claim, you should probably submit corrected claims to keep the record straight and to protect yourself in case of future audits. Correcting your claims shows that you were aware of the problem, corrected it on your own, and that you notified the carrier.

At that point, your responsibility has ended. Whether the carrier chooses to correct its file is up to them.

Check with your carrier for their policy on submitting corrected claims. Certain insurers may require you to submit an appeal request to change incorrect information submitted on a paid claim. In certain circumstances, you may need to submit an Overpayment Refund, followed by a new claim.

-Advice for Reader Questions and You Be the Expert contributed by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas; and Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.