Wiki Claim denied

[Gemini18]

I have a doctor who billed a 99222, the hospital billed an ER visit in error. The physician's claim was denied. The hospital is not able to change their billing to reflect the 99222.

Can the physician change his billing to reflect the ER?

 

[deeva456]

Hi!

I wouldnt change the doctor's billing...could be considered fraudulent just to get paid. I would appeal the denial with his report and any other corresponding documentation you may have to show that he admitted the patient and it wasnt an ER visit.

 

[rthames052006]

Hi!

I wouldnt change the doctor's billing...could be considered fraudulent just to get paid. I would appeal the denial with his report and any other corresponding documentation you may have to show that he admitted the patient and it wasnt an ER visit.

I agree with deeva456, when I was working IM, we had this issue come up every now and then and what I did was get the "admission" record and send in all the documentation to the insurance as deeva456 stated.

You will find that the hospital will "rarely" if ever change their billings.

Good luck,