Question Fee Schedule Question

kstine713

Networker
Messages
45
Best answers
0
Hello,

If a payer reimburses for a code at your full charge, and when you reach out to the payer you realize your allowable is higher than your charge, is it okay to send a corrected claim with higher charge on the code to maximize reimbursement for that service? If yes, can you send the corrected claim(s) only to that payer, if you didn't miss out on reimbursement from any other payers? (We would update the charge for all payers moving forward, but curious about going back.)

Thank you!
 

SharonCollachi

True Blue
Messages
2,178
Location
Clovis, CA
Best answers
3
You can send a corrected claim if you wish, but you may want to weigh the risks/benefits of doing so. A lot of corrected claims could throw up a red flag that causes them to do a lot of chart/billing audits, which could mean that you/your staff spend more time (money) dealing with that than you would gain by rebilling.
 

csperoni

True Blue
Messages
1,539
Location
Selden
Best answers
3
I would never submit a new claim with a different amount unless there was a data entry error in your system (like someone misplaced a decimal.) You did submit it with your correct fee at the time of service. I would count that first one as a learning experience.
This exact reason is why most offices have their fees so high and then just write off tons of contractual adjustments.
 
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