MnTwins29
True Blue
I am familiar with the regulation that requires providers to resubmit correct claims and pay back any overpayments to the federal government within 60 days of identifying the overpayment. However, does this apply if the incorrect claim did not result in an overpayment, but there were coding errors.
As an example, say a patient is an inpatient with whatever condition and has two complications coded, acute renal failure and acute respiratory failure. Review of the chart would reveal the renal failure was coded incorrectly, but the respiratory failure was correctly coded. Removing the renal failure from a corrected claim would not result in a DRG change, therefore there was no overpayment. Does the hospital then have an obligation to submit a corrected claim within the 60 days?
Thank you in advance for any help or advice you may have.
As an example, say a patient is an inpatient with whatever condition and has two complications coded, acute renal failure and acute respiratory failure. Review of the chart would reveal the renal failure was coded incorrectly, but the respiratory failure was correctly coded. Removing the renal failure from a corrected claim would not result in a DRG change, therefore there was no overpayment. Does the hospital then have an obligation to submit a corrected claim within the 60 days?
Thank you in advance for any help or advice you may have.
