aslover
New
I am performing auditing for a FQHC. They are changing coding (even if by only adding a modifier) and are billing the secondary on a HCFA when they billed the primary on a UB. They are modifying billing in their EDI system, which then does not match their revenue management system. When I share that they should make their corrections in their revenue management system to match the billing sent to the payer, bill on the same claim form for the secondary as they did for the primary - AND not change coding on just the secondary to bill different codes/modifiers than on the primary they push back that they have been doing this for some time and they're confident it's correct. Has anyone else ever experienced a state system that allows these nuances within the billing of healthcare claims?