Wiki Correcting Medicare Claims

[AprilSueMadison]

Our contractor is First Coast Service Options and I'd like to see if any of you have an idea before I call and try to get a CS rep to actually answer my questions (because they likely won't and tend to treat us like we are idiots when we don't know something).

I have Medicare claims that need to be corrected. Long story short, it took awhile for someone to catch the EHR was sending out incorrect codes and no one was trained to notice. So, I have a claim with a code 17110 on it. I follow the process and reopen the claim and send it (and others), with the correct forms and a corrected claim. The new claim has 10040 on it.

I get a letter back stating "Medicare cannot reopen this claim or make a change. Per Medicare, changing 17110 to 10040 will cause an overpayment. This decision cannot be appealed."

So....what is my next step? I can't appeal it, but I have to let Medicare know we made a mistake on the claims and send corrected information, right? How do submit a corrected claim in this case?

 

[CBlanton]

Can you cancel the claim, then resubmit a corrected one after the canceled one processes.

 

[AprilSueMadison]

Is that an option? These are old claims that have been paid and closed out as finalized in our system.

 

[CBlanton]

You have 1 year from the "from service date" to do an adjustment.

 

[goofy2lgm]

We have encountered this issue with NGS/WPS. The best way to handle this is to start clean, refund Medicare with letter of explanation and allow them enough time to process refund, then send in your corrected claim.