Is it in compliance to...

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Woodbridge, VA
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Scenario: a claim goes out with the wrong DOS and gets processed for payment. A correction must be submitted to the insurance of course...no doubt about that. But in our own practice management system, should we not keep that original "ticket" with the original information so as to keep a record of what we sent, even if the DOS was incorrect as in this example? Wouldn't we create a separate corrected ticket in our system? This is how it's been done as far as I can remember. We are now being told that it's okay to go into the original ticket and change the DOS in there and that there is no need to create a separate corrected claim. Is that within compliance?
 

thomas7331

True Blue
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From a compliance standpoint, I don't know that it's a major issue as long as you're not causing an overpayment or reporting error by doing it this way, and most electronic systems these days do have an audit trail somewhere so that this could be tracked down if necessary. But you may wish to take the extra step of posting the correction for accounting purposes or to leave a clear record of what was done, or else leave a note on the account in case there's every a question as to what happened. As you said, as long as you're ensuring that the corrected claim is sent so that the insurance company has accurate records, and if no potential for a payment error is caused by this, there wouldn't be a compliance issue that I know of.
 

sab001

Networker
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Pasadena/LaPorte Texas Chapter
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Always follow office written policy regarding resubmission of a corrected claim. If one if not in place, help to create one. Also, monitor the guidance provided by the payor. Some payors will require you complete one of their forms to explain the correction.

Systematically, if you can correct the date and resubmit the claim as 'corrected,' you should be okay.

By creating a new ticket, you run the risk of setting up a separate claim ID number. The payor may perceive the second number as a duplicate / false claim.
Document within the account the change you made and why you made it. If an audit occurs down the road, the auditor will have written explanation as to why you updated the date of service and corrected the claim.

Scott Burk, MBA, CPCO
 

rcmspt

New
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Either way

Either way you go; make sure to document, document, document. nothing like having to go back and track down the whole situation. Depending on how your practice management system works; some once the claim is out will not let you delete it. If you can just correct it; that should work. as the other replies stated; also make sure to follow payer guidelines.
 
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