REBILLING MEDICARE AFTER CORRECTING MODIFIER AND PLACE OF SERVICE

[arvsun]

Hello

If we are to rebill a claim for medicare with changing place of service from tele to in office (2 to 11) and modifier remains same 95 - and medicare has already paid, should we rebill as corrected claim with $0 INS Bal (since they already paid and they will pay the differential is the hope)

Thanks so much for help
AS

[Michele]

I'm not sure if I understand.  Why are you rebilling?  What was incorrect on the original claim, just the POS? 

[Michele]

I just reread your question to see if I missed something.  Did Medicare pay with the 02 POS?  I thought they required the 11 POS with 95 Modifier, but that is what you are saying you are correcting it to.

Sorry!  Still confused.  Can you provide more information?

[arvsun]

Yes, thanks for checking, They paid but we need to bill POS as 11 and thats where the question is

I just reread your question to see if I missed something.  Did Medicare pay with the 02 POS?  I thought they required the 11 POS with 95 Modifier, but that is what you are saying you are correcting it to.

Sorry!  Still confused.  Can you provide more information?

[kristin]

My two cents...

I bill for 3 different MAC's, and all of them have the same process for this situation. (Your MAC may be different, but I am not holding out any hope). You need to go into their portal (which you have to be registered for), and do a Claim Correction for POS. Once they receive that, they will send a letter asking you to refund what they already paid you, and once they get that refund, they will reprocess the claim for payment at the correct amount.

It may be possible to do this all on paper if you aren't registered with the portal. You will have to find the proper forms on their website.

I have never known Medicare to just pay more on a claim/ask for a refund for partial over-payment before. They are strict with their accounting practices.