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Claim denied

  1. #1
    Question Claim denied
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    I have a doctor who billed a 99222, the hospital billed an ER visit in error. The physician's claim was denied. The hospital is not able to change their billing to reflect the 99222.

    Can the physician change his billing to reflect the ER?

  2. Default
    Hi!

    I wouldnt change the doctor's billing...could be considered fraudulent just to get paid. I would appeal the denial with his report and any other corresponding documentation you may have to show that he admitted the patient and it wasnt an ER visit.

  3. #3
    Default
    Quote Originally Posted by deeva456 View Post
    Hi!

    I wouldnt change the doctor's billing...could be considered fraudulent just to get paid. I would appeal the denial with his report and any other corresponding documentation you may have to show that he admitted the patient and it wasnt an ER visit.
    I agree with deeva456, when I was working IM, we had this issue come up every now and then and what I did was get the "admission" record and send in all the documentation to the insurance as deeva456 stated.

    You will find that the hospital will "rarely" if ever change their billings.

    Good luck,
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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