Author Topic: Recovering Deny Medicaid Claims  (Read 2895 times)

RCC

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Recovering Deny Medicaid Claims
« on: January 24, 2014, 02:54:57 PM »
How do you charge for doing claims that were denied, because they entered the wrong codes. The claims are for medicaid nyc. Is it more time consuming resubmitting old claims? I am new at this. Thanks for all the responses in advance.

Merry

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Re: Recovering Deny Medicaid Claims
« Reply #1 on: January 24, 2014, 05:21:28 PM »
Who is "they". Are you a billing service and asking if the provider gave you the incorrect codes and then you had to rebill with the new codes because the claims were denied? Happy to help if you could clarify so that we can all give you the information that you need.

Merry

PMRNC

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Re: Recovering Deny Medicaid Claims
« Reply #2 on: January 25, 2014, 12:02:09 PM »

Quote
How do you charge for doing claims that were denied, because they entered the wrong codes. The claims are for medicaid nyc. Is it more time consuming resubmitting old claims? I am new at this. Thanks for all the responses in advance.

I too am unsure what your asking. I think your asking as an independent biller or billing company? The question can only be answered by reviewing your contract. If you contracted on a % of collections/revenue.. you might be SOL.. this is the downside to % billing. If you charge per claim, flat monthly fee, hourly rate, etc.. then of course you have more options. It depends on YOUR contract. If you do NOT have a contract or agreement with the provider..well no one can answer this for you.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RCC

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Re: Recovering Deny Medicaid Claims
« Reply #3 on: January 25, 2014, 04:24:53 PM »
I am a new biller and I need to give a quote on doing the claims that they billed medicaid with the wrong codes. They are asking me to clean up their mess. Just not sure how to price this.

PMRNC

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Re: Recovering Deny Medicaid Claims
« Reply #4 on: January 25, 2014, 04:37:22 PM »
Ok.. well do NOT do a % or you will go broke. Instead look at the denials, try to determine any common denominator.. remember that regulatory issues say if YOU know of an "incorrect" claim (coded or otherwise) your legally responsible. IF I was doing a pricing for JUST Medicaid claims.. I'd go for an hourly rate (consulting fee) because you could end up working a ton of hours and never get paid.
Don't know what your experience is but that would determine the rate you can ask for and of course depends on your area.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

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Re: Recovering Deny Medicaid Claims
« Reply #5 on: January 25, 2014, 04:41:48 PM »
First of all I would check to see that you can still submit the claims..meaning that the dates of service are within the timely filing guidelines for Medicaid. Be sure also that you have all the source documents showing the new codes for these claims. This is not information that you get over the phone but on paper from the office. Do you need to do research on these claims? Or is it just the incorrect codes?
No research? I think you could charge a per claim charge..research?..you would need to charge for your time to do the research.

Is this a consistent issue in the office? It is not uncommon for a provider to test a new biller and give them old claims. Unfortunately a new biller may not know that these claims cannot be submitted any longer for various reasons. Doctors have a way of turning over their problem claims to new billers and expect magic. Please share with us if these claims are within the Medicaid guidelines for resubmission. And do the claims all involve the same codes that are incorrect?
Sorry for all the questions. It just gives us a better way to help you.

Merry

RCC

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Re: Recovering Deny Medicaid Claims
« Reply #6 on: January 25, 2014, 04:59:17 PM »
No I appreciate the questions, I am a new biller in training. I love this forum the experience and advise is priceless. I really appreciate all of you. Yes they have made the same mistake on all of their claims, from my understanding the woman whom I believe is the office manager, they do their own billing, so now that they made these mistakes she said she has six years of medicaid billing that they billed the wrong code for. But she gave me a range for the last six months totaling 1917 claims that they used the wrong code on. We are good friends with the doctor and he audited the office and found these mistakes, so he really wants to give us the billing, but i believe she doesnt want to lose her position. Politics. I am just glad that we will get something out of this, whether its doing this corrections then get the billing account.

Thanks

PMRNC

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Re: Recovering Deny Medicaid Claims
« Reply #7 on: January 25, 2014, 05:27:55 PM »
This might be a lot more than you can bite off on a new account and being new yourself.. First thing that concerns me is the admission that all those claims were billed INCORRECTLY, having it be Medicaid that's another red flag for me.  IT may not be as simple as re-submission so you want to first find out WHAT the problem is. Some may disagree with me, but I wouldn't touch this with a 10 foot pole w/out a contract to analyze.. you could go through all this trouble to determine WHAT the problem is..find it and be out HOURS of work w/out getting paid a dime.   I do an initial assessment and then I offer an analysis period and contract so I can get paid for the work I do. Since your dealing with Medicaid I would especially recommend a contract to analyze the accounts.



Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

PMRNC

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Re: Recovering Deny Medicaid Claims
« Reply #8 on: January 25, 2014, 05:30:01 PM »
Also you have to remember your liability.. IF YOU KNOW of a problem.. especially one like this where all claims were incorrectly billed.. JUST knowing of the error makes you responsible under any contractual obligation.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

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Re: Recovering Deny Medicaid Claims
« Reply #9 on: January 25, 2014, 06:01:27 PM »
I think Linda and I said the same thing except she elaborated more than I did. That is why I asked if they were all the same codes.
Here is my red flag..and something that you may not be aware of. This is not to scare you but to inform you.

Claims with the same codes got denied. Somebody looks at this and says..that is a lot of money sitting there and lets use another code to see if it can get paid. So as a new biller, I will tell you that the claims with the appropriate diagnosis and procedure codes must be supported in the patient's medical record. I will tell you that for sure, this will flag the computer at Medicaid. If it were just a few..not as much of a problem as long as the medical record was in line with the claim but this many claims..!!!! I would be very concerned.

As a new biller, there is much more responsibility that you have than just doing computer keyboarding. Please be sure to cover yourself, make sure that your Business Associate Agreement is in place as well as your contract that spells everything out. But all of that will NOT protect you if they are looking to use another code in order to get paid. I think this is more of a job for a professional biller than for a new person.

The information that I saw on the Internet dated March 2013 is that NY has a 90 day filing limit. Anything beyond that would not get paid.

I think what we are telling you is that this may not be the best situation for you to get into.

In no way am I saying that there is anyone doing anything inappropriate or illegal. Just too many unanswered questions that cannot even be asked unless someone with experience looked at this situation.
My take on this.

Merry

RCC

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Re: Recovering Deny Medicaid Claims
« Reply #10 on: January 25, 2014, 06:10:43 PM »
Ok, so I need to have an experienced Biller to look over this account before agreeing on anything. Thanks for the information, I think I need to hire an experienced Biller to assist me and so me the ropes there is so much to know and I want to do this right and nit violate any laws. I was going to check with Medicaid also.

PMRNC

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Re: Recovering Deny Medicaid Claims
« Reply #11 on: January 25, 2014, 06:35:54 PM »

Quote
Ok, so I need to have an experienced Biller to look over this account before agreeing on anything. Thanks for the information, I think I need to hire an experienced Biller to assist me and so me the ropes there is so much to know and I want to do this right and nit violate any laws. I was going to check with Medicaid also.

Don't jump the gun.. for now you have not lost anything.. find out what you are dealing with first.. in as much detail as possible.. one step at a time. It could be a good acct to get your feet wet, just saying you need to protect yourself but at the same time be compensated for your time. The more you know about these accounts the better you can proceed.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Merry

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Re: Recovering Deny Medicaid Claims
« Reply #12 on: January 25, 2014, 07:47:00 PM »
I would only call Medicaid of you have the approval of the doctor. Just your calling may open a can of worms.

You seem to be very through and asking good questions. It is difficult to know what you do not know which is why we are trying to help you through this.

Keep us updated please. And good luck

RCC

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Re: Recovering Deny Medicaid Claims
« Reply #13 on: January 27, 2014, 05:36:43 PM »
Since I will be doing research to find out why the claims were denied, would you suggest I do a per claim charge and would $4 be sufficient?

PMRNC

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Re: Recovering Deny Medicaid Claims
« Reply #14 on: January 28, 2014, 12:16:19 PM »
I personally don't like a per claim fee when I have not even decided what the problem is.. that's more consulting for now. What I do if a provider needs some research or even a practice analysis is have them sign the appropriate HIPAA Associates agreement. Then I sit down and figure out what they need, what reports I need. For your particular situation you want to see EOB's which will have what you need to get an idea of what's going on.. you will also want to run a full A/R and claims detail for all Medicaid. What I would do is charge an hourly consult fee, log your time, make sure you have at least a basic consulting contract signed along with your HIPAA Associates Agreement.. you could actually make this into a marketing thing where you offer a very reasonable hourly rate and discount and even a trial period. Then you get to see what your in for if you take the account further and they get the benefit of your experience/knowledge and you have an incentive to do right but also get paid for all time you put in. You don't want to do a per claim fee because your not sure what your submitting just now, you also won't have a billing contract so billing those claims should be OUT until you have a full contract for billing services in addition to all the necessary agreements in place.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com