Wiki Correcting E/M codes after audit

[amcdaniels1]

Following a routine E/M audit of employed providers, whose responsibility is it to correct the billing if codes are incorrect? All audits are reviewed with the appropriate providers. Should billing be corrected if it's only undercoded or overcoded by one level? Would a lot of changes to paid claims for coding changes trigger outside audits? I'd like to know what the best practices are out there-- thanks!

 

[JDACPC]

An improper claim is an improper claim, no matter the level. It's the office's responsibility to get the claims corrected without fear of future audits. Corrected claims happen all the time, it may or may not trigger an audit. If you ignore the corrections, that will certainly look worse on any future audit, that you were aware and did not react and submit corrections.

It would also be wise to put an education/audit plan in place to stop this from happening in the future and would show any auditor your good-faith effort to continuous education and proper coding.

Corrected claims/resubmissions/refunds are a pain but it simply must be done each and every time.

 

[cheermom68]

Medicare requires repayment or adjustment within 60 days of discovery of error or it can be considered a false claim.

 

[slivingston]

Just a thought to avoid this issue in the future, do the audits pre-submission. Our practice will pull random encounters prior to submission and we do the audits before they even get billed out. That way there are no corrected claims involved.