Question Correcting claims

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Just curious if it is common practice now for coders to correct and resubmit their own claims? At my practice the biller has always done corrections and resubmissions but now they want the coders to correct their own claims, how does your practice handle this? Does anyone know if claim correction is taught in the training courses? Appreciate any input, Thanks!
 

Chelle-Lynn

True Blue
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It will depend on the carrier.
  • We have some carriers that will not accept the electronic corrected process noted above by using box 22 on the HCFA
  • Other carriers allow the electronic corrected claim process you mention above by utilizing box 22 on HCFA form
  • We have some that require an appeal or redetermination letter to be submitted along with Medical Records to verify the change.
  • Depending on the Medicare carrier; some will require that the claim be canceled and resubmitted
Each carrier will have their own process and your billing office should be familiar with what is needed for each circumstance.
 

Chelle-Lynn

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Many offices are putting new policies into place regarding coding correction. In most cases this is an attempt to streamline the process and avoid the appearance any compliance issues. In other cases it is part of the on-going training process to have the coder correct their work so that they can learn from their mistakes. As noted by the contributor above in some offices they have dual positions where the billers/coders are one and the same.

There is no industry "right way" for an office to handle these situations. From a compliance point of view most auditors will look for a clear process and P&P showing who is responsible and authorized to make coding corrections and that these policies are followed.

If your coders are looking for billing training, there is the CPB certification and class. This may just be an opportunity for internal training to ensure that the coders are clear as to what is needed on a 1505 or UB04 form for the claim to be considered a "corrected claim" and not deny as duplicate.
 

Pam Ziegenhorn

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Incorrect ICD 10 codes accidently entered on patient and not all charges(professional) entered. The biller "billed" the claim. Biller states claim can not be corrected. I disagree. What is the process to correct the claim to ensure an accurate claim? The wrong codes entered will not meet medical necessity for procedures and tests done. Also this is a critical patient who needs correct codes for encounter. Your help is greatly appreciated, Thanks much for any help!
 

Chelle-Lynn

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Unfortunately errors like this can occur. Depending on the carrier there are various options for correcting these claims.

  • Send a cancellation of the original claim and once retracted submit a new bill
  • Submit a correct claim electronically (there are specific codes depending on the claim form to indicate a corrected claim)
  • Submit a reconsideration or appeal with the carrier with the corrected claim form and the medical records to support the changes.
  • Submit a letter, corrected claim, and the medical records explaining the corrections and requesting reprocessing.

This may be a training issue with the biller in question. Both the physician and the insurance carrier need to ensure that they are processing the claims accurately and when a coding error is made there is always a process in which a "corrected claim" can be submitted. If your office determines that a claim was submitted with incorrect codes either ICD, HCPCS, or CPT, then they are responsible to correct the claim. Otherwise this becomes a compliance issue since they have identified an error and are knowingly not taking steps to correct the issue.

We always need to make sure we are ethical. I would suggest taking this to the next in the line of administration such as a supervisor, manager, or compliance officer for additional review. Often times these issues are just a matter of training with the billing staff and can be easily resolved.
 

Pam Ziegenhorn

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Unfortunately errors like this can occur. Depending on the carrier there are various options for correcting these claims.

  • Send a cancellation of the original claim and once retracted submit a new bill
  • Submit a correct claim electronically (there are specific codes depending on the claim form to indicate a corrected claim)
  • Submit a reconsideration or appeal with the carrier with the corrected claim form and the medical records to support the changes.
  • Submit a letter, corrected claim, and the medical records explaining the corrections and requesting reprocessing.

This may be a training issue with the biller in question. Both the physician and the insurance carrier need to ensure that they are processing the claims accurately and when a coding error is made there is always a process in which a "corrected claim" can be submitted. If your office determines that a claim was submitted with incorrect codes either ICD, HCPCS, or CPT, then they are responsible to correct the claim. Otherwise this becomes a compliance issue since they have identified an error and are knowingly not taking steps to correct the issue.

We always need to make sure we are ethical. I would suggest taking this to the next in the line of administration such as a supervisor, manager, or compliance officer for additional review. Often times these issues are just a matter of training with the billing staff and can be easily resolved.
 

DeBillingTater

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Unfortunately errors like this can occur. Depending on the carrier there are various options for correcting these claims.

  • Send a cancellation of the original claim and once retracted submit a new bill
  • Submit a correct claim electronically (there are specific codes depending on the claim form to indicate a corrected claim)
  • Submit a reconsideration or appeal with the carrier with the corrected claim form and the medical records to support the changes.
  • Submit a letter, corrected claim, and the medical records explaining the corrections and requesting reprocessing.

This may be a training issue with the biller in question. Both the physician and the insurance carrier need to ensure that they are processing the claims accurately and when a coding error is made there is always a process in which a "corrected claim" can be submitted. If your office determines that a claim was submitted with incorrect codes either ICD, HCPCS, or CPT, then they are responsible to correct the claim. Otherwise this becomes a compliance issue since they have identified an error and are knowingly not taking steps to correct the issue.

We always need to make sure we are ethical. I would suggest taking this to the next in the line of administration such as a supervisor, manager, or compliance officer for additional review. Often times these issues are just a matter of training with the billing staff and can be easily resolved.
Chelle,

In cases like these, is sending a cancellation always necessary? Or is possible to bypass that step through sending a "corrected claim" with the Box 22 and the claim ID listed? Also, the medical record to support the charges isn't always entirely necessary, especially ICD-10 coding errors. Have you found that to be necessary as well with every corrected claim?

Thanks,
Tater
 
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