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Rant and Question

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DMK:
True, with all the time you spent researching, and I do appreciate your adhering to the rules, why not try.  The worst they'll say is no.  If the insurance company questions you, you can honestly tell them you were TOLD to bill it.  As long as you're not monkeying with claims (changing dates of service or dx or modifiers) to get them paid, you're not doing anything illegal.

PMRNC:
Ok, so they want you to change the units and rebill? I'm not real clear on the circumstances reading this myself, but if they want you to change the claim but documentation doesn't support the change, you are 100% correct, that's fraud. Since you mention you need ANOTHER remit, I am still curious as to the claim status on the clean claim previously submitted, maybe I am not reading this correctly.


--- Quote ---Well according to previous posts  you might get an adjustor who is having a good day and get the claim paid :-)
--- End quote ---

Charlene, wasn't it you that said to let this rest? if you are going to make such a statement where clearly you are chastising me for telling you what really goes on.. Ever hear of the saying "Don't shoot the messenger"?  You yourself say you have gotten claims overturned that were previously rejected for timely filing.. did you not? Were they erroneously denied? What was basis for your appeal? Seems to me it would be more relevant to share that then a nasty quip meant towards me.    

Pay_My_Claims:
Linda, I was going to reply, but it would be useless. If you believe that, I'm sorry but I refuse to keep going back and forth. I told you before my replies to you were taken out of hand and context, and only you can see fault in my post. You didn't see it in the other one, and you won't see it in this one. Nuff said for me.

blhoffman:
Situation is Primary does not pay. We do not expect payment but require a correct denial to submit to Secondary for payment. Claim was denied by Primary correctly, but never submitted to Secondary timely and when submitted it denied for timely filing. We know it was untimely. She just wants us to rebill the Primary to get new remit to rebill Secondary so we are timley according to the date on remit. BUT we billed a clean claim and there is absolutely nothing wrong with the original claim to resubmit a new one to the Primary. I searched for anything, something to allow me to get the money. This was my situation.

My co-worker is the same, except last week she told her to just remove one of the services we did perform to have a change on the claim so we can rebill. The original claim was clean, we did do the service and unless we are going to remove services for all patients we can't just decide to remove and not get paid for services randomly to get new remits so we can get updated remits to submit to Secondary. Right? I mean that is false billing. Especially the timesheets for our workers are on file and clearly shows we did the service and we clearly paid that worker for the service on her paycheck. Am I right?

I understand appealing timely. I do it all the time but I have to have a leg to stand on even is it is a splinter of a leg. I just pulled in $129,160 for one patient that 4 people have touched for a year and couldn't get the money. I worked it for 2 months and got most of it. I am appealing the other 5 months and by the time I am done I hope to have all $250,000 or her. I am appealing the timely as we speak, because I have the insurance law to back my appeal.

dekenn:
Even if you do resubmit the secondary, wouldn't it just deny as duplicate?  In my experience, yes, you might get the new "date" on the explanation of benefits, but it will show being denied as duplicate, instead of not being covered.

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