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.