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Should my office notify Medicare of a billing error for sedation codes?

  1. #1
    Question Should my office notify Medicare of a billing error for sedation codes?
    Medical Coding Books
    I am trying to locate a real person employed by Medicare, possibly a local Alaska State rep. My question is, should I notify Medicare of an error that the office found an error in the number of units of a specific CPT we have billed to CMS. The last office I worked at we contacted our CMS rep. I am new to Juneau and we are pretty limited in resources. Any suggestions would be helpful. Thank you in advance.

  2. #2
    If you have identified a billing error that has caused an overpayment, especially recurring, your should DEFINITELY talk to your administrator and complaince officer/attorney about informing Medicare. If the overpayment is substantial and you can calculate the amount of overpayment then you can send a refund check to Medicare with the Voluntary Refund Form with an attachment identifying each patient/HIC/DOS/ICN/amount of line item refund. If you are unable to calculate the overpayment amount then you should contact your Medicare carrier and report the issue and ask for guidance.

    I googled Alaska Medicare Part B and I came up with Noridan. If this is your correct carrier below is their contact information. In addition, I have added the link to their Voluntary Refund Form.

    Provider Contact Center
    Available Monday – Friday,
    8:00 a.m. – 4:00 p.m. in Respective Time Zone (800) 933-0614

    Julie, CPC
    Last edited by jdrueppel; 12-18-2008 at 08:43 PM.

  3. #3
    Thank you for your reply and info. I called Noridian before I sent out the email and they suggested I call and request the phone reopening line. This is for changes such as units, modifiers, month and day changes, ICD-9 and CPT codes if down coding. I am not familiar with this process and I will check into it. I do not think we will have to refund any payments because Medicare has denied for wrong # of units. I am in the process of doing an audit on these codes for the past year and half.
    I am new to this office (Orthopedic Surgeons and PT) and I am working on trying to show them the importance and need for a compliance/quality person. This is a small office and training and education is only through travel to the mainland or via the Web. It is a challange to get staff to trust me when I try to educate them. I find I have to take very small steps and always back up my info with a hard copy of the info.
    Thanks again for your assistance.

  4. #4
    Whenever I submitted a claim with errors to an insurance company, I called the company to explain the error and obtained the name of a contact person/supervisor. I then printed out a corrected claim and sent it with a letter addressed to the contact person explaining the error and the reason for the resubmission. I have had no problems yet.

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