We are being audited by a Medicaid hmo company for 5 charts going back 3 years. If we find a dx error that does not match the documentation (the cpt code is correct) that is older than one year old, what is the best course of action to take? Leave as is, or acknowledge the error by sending a corrected claim with corrected dx along with the documentation or what? Thanks for any help I can get on this.
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Wiki Insurance audits
- Thread starter Bettyf
- Start date
Kisalyn
Expert
I would call and ask them what they want you to do. Maybe they can correct over the phone. Otherwise, it'll likely be a corrected claim.
Is it on one of the five charts they requested? Usually, if the insurance audits, they go ahead and make the correction in their system.
Is it on one of the five charts they requested? Usually, if the insurance audits, they go ahead and make the correction in their system.
mitchellde
True Blue
at 3 years a corrected claim is out of timely filing. If they are auditing for diagnosis code and yours was incorrect then you may have to take this one on the chin. If the incorrect code was assigned to affect reimbursement this could be a bigger problem that you realize. I think you just have to send the charts as is and make a concerted effort that this never happens again.I have run into a ton of providers and coders that will use a dx code that gets paid as opposed to the correct one.