Wiki Visit billed on wrong DOS

[morriam91]

I am currently having an issue where our biller is posting the patient's visits to the wrong date of service. Example: Patient was seen on 5/4/21, but when the charges are entered into the system she by mistake puts the date of service as 5/14/21. I have a handful of claims that have been sent out to insurance companies and paid already. My questions is do I bother submitting corrected claims for these dates of service? I am assuming that it matters if the insurance companies were ever to do an audit because the DOS in the EHR and the DOS in the billing record would not match up. I just don't want to have to deal with sending all those corrected claims out and the insurance companies taking back money. Any advice would be welcome. Thank you!

 

[thranowski]

I definitely would. An audit discovering the discrepancies would be a bigger mess than just refiling with the corrected dates. You run the risk of being accused of fraud, they start looking at other charts more closely, there could be fines, etc etc.

 

[Orthocoderpgu]

You need to send corrected claims with the right DOS. As you pointed out the documentation needs to support the codes submitted, that includes the DOS.

 

[thomas7331]

I agree, I would send the corrected claims - an incorrect date of service can make a difference in a lot of ways (e.g. duplicate claims that may get paid or denied in error, global surgical periods, maximum benefits in a given time frame, deductibles and out-of-pocket calculations, etc.) so it's best to make sure the insurance company's record is correct. Totally understand that this is likely to be a real headache to fix - if I was in charge, I'd make the biller who caused the errors do the work so they'd remember not to do it again.

 

[morriam91]

I agree, I would send the corrected claims - an incorrect date of service can make a difference in a lot of ways (e.g. duplicate claims that may get paid or denied in error, global surgical periods, maximum benefits in a given time frame, deductibles and out-of-pocket calculations, etc.) so it's best to make sure the insurance company's record is correct. Totally understand that this is likely to be a real headache to fix - if I was in charge, I'd make the biller who caused the errors do the work so they'd remember not to do it again.

That's a great idea. Now if I can just make sure they send in the corrected claims correct. Thank you for your response!

 

[SharonCollachi]

Make sure you use the "replacement" resubmission code, which is "7".

 

[jbhuju]

yes i ahd few last month when we enter claim on portal biller entered worng DOS so after we get payment we found out it was wrong DOS, so we send corrected claim with corrected DOS.