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Medicare modifier help please

  1. #1
    Default Medicare modifier help please
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    Hi All,

    I am having a problem with one of my medicare claim. They were giving us different responses on a single claim that is getting denied as a DUPLICATE CLAIM. I was billing the code Q4106-JC with 96 units. Accidentally when I billed this code I forgot to change the unit and was submitted with 1 unit. We got paid with that 1 unit. I am now re-submitting this claim with 96 units and marked box 19 of the HCFA FORM with "CORRECTED BILL". When medicare gets this claim it was denied as duplicate claim. We are trying to appeal it but they were instructing us to resubmit the claim with a "modifier that will state that this is a corrected claim". Please need your help what modifier this is. I already looked up in palmetto website for a certain modifier but can't find any. If you've experience this with your Medicare claim please share what correction you did or what modifier will state that the claim is corrected. Thanks your very much for your help.


  2. #2
    Columbia, MO
    If you are submitting the corrected claim electronically then you need to check with the carrier to see if they accept corrected claims electronically. Because if they do not then the second claim will be recognized as a duplicate. You may need to do this as a paper claim which you make as a corrected claim across the top of the claim, I also always submit a cover letter with the claim to detail what is being corrected and why.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Thanks for your quick response. I actually don't have problem with our submission electronically. Medicare themselves got our claim. We were appealing our claim and thru phone conversation they are suggesting that we should use this modifier so that our claim should appear to them as a corrected claim. They would not say what modifier to use. They just told us to go to the palmetto website and to modifier look up. I already scanned those modifiers, I'm not sure if I missed one but nothing states a modifier for a corrected bill. There is a CC modifier but this is if you change a code for correction.

  4. #4
    Columbia, MO
    The is no modifier for a corrected claim. They must have a way to adjudicate electronically a corrected claim. It sounds like they cannot. Honestly most carriers have no way to do this and corrected claims must be a paper resubmission. Those carries that can will tell you to use the word corrected claim in box 19. Without the carrier telling you to this then they will not recognise this as a corrected claim if that is what you do. You will need to submit via paper. Then with a black sharpiue you write with all caps across the top of the 1500 CORRECTED CLAIM. But there has not been a modifier created for this purpose.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    There is a new modifier CC for corrected code. I'm not sure if this will work for you but it would be worth investigating.

  6. Default
    Modifier CC is for a procedure code change. This CC modifier wouldn't be appropriate as you are correcting number of units being billed.

  7. #7
    Anchorage, Alaska
    Does your Medicare intermediary offer telephone reopenings for corrected claims for billing errors. Noridian does (as well as their on-line Endeavor system). This is how you would correct the claim for the number of units in Noridian's jurisdiction.


  8. #8
    Everett, WA
    We had a similar issue with an incorrect number of billed units. We had billed one instead of the 80 that was actually given. A simple error sometimes does not yield a simple solution. First we were advised by WPS to call the reopening line (which we did) and changed the units. But the claim was still denied. After researching the WPS website discovered that due to the corrected high dollar amount (over 7K??), we had to file a redetermination appeal and did so via fax. Although the amount was eventually paid the billing error did cause the practice to have to wait 8 months to receive the correct reimbursement!
    Suzanne E. Byrum CPC

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