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Rebilling a denied claim

  1. Default Rebilling a denied claim
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    Is it "legal" to rebill a claim that was denied for being non covered with a code that you know will be covered. Example: Patient comes in for a physical and you bill a physical procedure with a V70.0. Claim is denied because patient does not have preventative coverage. So doctor wants to rebill with an E/M code , say 99215 with symptom diganosis'. Or another scenario: patient is seen for a particular symptom that isnt covered and doctor wants to rebill with a previous diagnosis that he didnt actually see the patient for at that time, but has in the past. ( I think I already know what the answer is....)

  2. Thumbs down Sounds like fraud to me...
    That sounds like fraud. If the claim was originally billed incorrectly, ok to do corrected claim with corrected codes. If the pt came in for a routine health exam, cc was routine exam and routine exam was done, you have nothing to support your rebill (even if you did review chronic problems etc.). I would say go with your gut, bill for what was done and leave it at that. Sounds like doctor needs a refresher on the definition of fraud. Good Luck .

  3. #3
    I agree, this is fraud.

    Many times claims will be denied in error or the wrong code is put on in error. In those cases by all means fight it out and rebill correctly.

    There is a big difference in not being covered because it is a benefit issue and not being covered because it is a coding issue.

    Instead of having to dea with the complaints your practice needs to be more proactive about what is covered and what isn't covered and letting your patients know up front. This is a customer service issue, not a coding issue and that is how it needs to be handled.

    Good luck,

    Laura, CPC, CEMC

  4. #4
    I agree as well, that sounds like fraud to me as well. Corrected claims due to a billing error on the original bill should be reviewed for proper payment, but if you send a bill for something that was not documented in the notes for that date just to be paid it is fraud.
    Melony Reed CPC

  5. Default
    Thank you so much for your answers. I do not and have not felt comfortable about doing this and I just wanted to make sure that my feelings are justified. I am going to let the doctors know.

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