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AprilSueMadison

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Okay, so I found a problem in our coding for 17110. Depending on what the MA clicks for the extraction of milia, it comes through with a destruction code, which is incorrect.

These have been billed and paid for, obviously I need to fix this.

I've never found quite a problem like this before, but for one doctor this year alone it totals 25 charts. Not a lot in the scheme of things, which is why it was missed, but a lot to refund for sure.

How far back do I need to go to get this corrected? For me personally, I can only audit from our EHR (June of 2011). I know nothing about our old paper system, but our old charts are scanned into the new system. I simply have no way of narrowing down what chart may have 17110 in it from before June of 2011.

If I find a chart that is two years old....I refund and send a corrected claim, won't I run into timely problems and not get paid for the corrected code?
 
Any ideas? I'm especially interested in "If I find a chart that is two years old....I refund and send a corrected claim, won't I run into timely problems and not get paid for the corrected code? "
 
Hi AprilSue,
I would say to look at your State law and kind of go from there.
For example, here in FL, the Statutes dictate that for the majority of over/underpayments audit requests (Unless Fraud is suspected or if it's for Federal members, in which case there's a 5-year go back period) can only go back one year from the PAID DATE. I think you'll definitely have issues in re: to Timely Filing rejections if you exceed a year, and possibly less. I know you want to do the right thing, and I can certainly appreciate that. I just think you'll have an issue with getting the new claims processed if you exceed a year. Just my thoughts. :)
 
AprilSue,

You may want to run this situation by your legal department for their advise.
 
I've gone back and have done a thorough audit of the code and have my results. My office is contacting a health care lawyer to find out what exactly we need to do because I certainly don't know, and the billing manager doesn't know either.

To stop the problem from happening I have started to code every record. Next week everyone will receive a basics of coding for our specialty (trained by me) so hopefully they can recognize when problems arise.

Beckipoff, I'm actually in Florida as well. Do you have that statute information?
 
Hi AprilSue.
Reference FS 641.3155 and 627.6131-

For FS # 641.3155, look at #16 that begins with "Notwithstanding the 30-month period provided in subsection.......".

For FS # 627.6131, look at # # 19 that begins with the same verbiage

It does depend on what type of provider you work for, as the 12-months applies to all MD's, DO's, and a few other specialties (DPM and DC, too, I think). Hope this helps!
 
AprilSue,

You said "Depending on what the MA clicks for the extraction of milia, it comes through with a destruction code, which is incorrect.".....do you mean what she 'clicks' in the EHR? If so, and your EHR has only been in place since June of 2011, then maybe it isn't as big an issue as you initially thought? Just a thought. Forgive me if I am off base. :eek:
Hope that helps-
Michelle
 
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