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pattilebeau

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hi
Any assistance at all to this question would be greatly appreciated.
We have a procedure that we do in our ASC. When the fee was entered into our charge master, it was entered incorrectly as 1700.00 and it should have been 17,000.00.
I have 6 Medicare claims that need to be corrected. I called Medicare and they said it is fine to do corrected claims. The problem is, our Compliance officer and our CFO say this is illegal and they will not allow us to do it. I am wondering, asking, if anyone knows where I can get written, legal, confirmation that this is NOT illegal and that I can send out corrected claims.
Please help. 36k in reimbursement is at stake. thanks in advance.
Patti -
 
https://www.palmettogba.com/palmett...urces~FAQs~General~8X6SSF8362?open&navmenu=||

Not sure if this will help but it goes over the timely filing limitations for a corrected claim. Thus, allowing a provider to send in a corrected claim, etc.
"All claims must be filed with your Medicare contractor no later than one calendar year (12 months) from the date of service or Medicare will deny them. If a claim requires correction, a corrected claim must be filed 12 months from the date of service. The fact that the original submission was filed timely does not change the timely filing period for a corrected claim. Each claim filed to Medicare is considered individually and claims that are denied for timely filing do not have appeal rights.

Filing a claim to Medicare as soon as possible after the service is rendered can help to ensure there is time to resubmit a corrected claim, if necessary. For additional information about the new maximum period for claims submission filing dates, contact your Medicare contractor or review the MLN Matters articles listed below related to this subject:"
 
I have attached the Medicare CMS guidelines for reopening and revisions of claims. Sending revised claims is an allowable action. The term "illegal" would not apply.

With that said, the Compliance Officer may be taking into account additional factors that would affect the decision making process on this issue. Previous audits from Medicare, investigations, etc. Often times there are additional factors that the billing office may not be aware. I would review the attached link and manual pages with them and ask for clarification on their decision process.

Ultimately, the final decision lies with the Compliance Officer and CFO of the organization. If you have done your due diligence by bringing these guidelines to their attention and their decision is to not send corrected claims, then this outcome would resides with them and would not be a reflection on you or your billing office.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c34.pdf
 
Thank You Both

I want to thank you both for your responses. I will present this information to the CFO and the compliance manager and hopefully, they will be amenable to filing the corrected claims. I really do appreciate you taking the effort and time to help me.
Have a great day.
Patti LeBeau
 
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