Wiki Corrected claim with new prices

[hparra112e@gmail.com]

Hello all,

I have recently discovered our out of network practice has been under billing for a procedure. Based off our zip code from the Fair Health UCR rates, we should have been billing $1600 for 20553 but have only been billing $800.

Can I reach out to the insurance companies and change our past claims somehow?

Thanks

 

[CodingKing]

I don't no believe you can update your rates retroactively. If you could you would have to rebill every insurance company and any patient who received services since you cannot have multiple fee schedules. The of course you will also need to go back and attempt to collect money from every patient who has an increase cost share due to increased rates.

 

[thomas7331]

I don't think there's anything that specifically prohibits submitted a corrected claim with a corrected charge amount - I've seen this done by providers on occasion. But I agree with the points in the last post - it would need to be done for all payers. A corrected claim should be just that - a new claim that corrects an error that was made. So if the under-billing was due to discovering an actual mistake in the way the fee schedule was entered or configured, that would be one thing and could be supported, but just retro-actively changing the fee schedule to try to obtain additional payment could be considered a questionable practice that could potentially cause you some problems.

 

[honeybee]

It will probably depend on the ins company but we have made these type of corrections before and even did so to quite a number of our Medicare claims last year because we realized the billed amount was not high enough to allow payment for the full allowable. We spoke to Medicare and were advised we could do this and did them as phone reopenings with no issues. I have also occasionally done them with BCBS for a splint code.