Billing > Billing
Need advice about a very costly corrected claim issue...
PMRNC:
--- Quote ---By the time she gives me the EOB's she has already deposited the checks sometimes weeks before so I couldn't return the checks in this situation...
The reason the amount is so high is that I do her billing once a month. So these 4 patients had seen her once a week for 3 or 4 weeks so I billed somewhere around 13 sessions with the wrong code which the insurance paid the full amount for again the 2nd time while I was trying to correct the claim- like $68 so $68 X 13 sessions = way too much money!!!
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I still say best way is to refund the full amount and let them back out and reprocess all claims. JUST make sure you send a letter and corrected claims!
--- Quote ---If it is Blue Cross/Blue Shield, they will recoup the money off of next payments. Any other carriers, I would just call them and find out what their requirements are and the address to send refund.
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The problem with that is it is a messy task.. the incorrect claims are from one patient's file. It does throw off the books when you have them taking the payments off of other patients/claims. It's just so much neater to send back the money and let them re-process. When a carrier takes payment off of other claims it messes up the audit trail.
rdmoore2003:
--- Quote from: PMRNC on October 22, 2013, 05:23:44 PM ---[The problem with that is it is a messy task.. the incorrect claims are from one patient's file. It does throw off the books when you have them taking the payments off of other patients/claims. It's just so much neater to send back the money and let them re-process. When a carrier takes payment off of other claims it messes up the audit trail.
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Every time I have attempted to send BCBS refunds, they have always returned the refunds and sent letter stating it will come out of next eob. I have spoken with our provider relations rep and sent in letter with corrected eobs, etc and bcbs of la will not take the refund check.
PMRNC:
--- Quote ---Every time I have attempted to send BCBS refunds, they have always returned the refunds and sent letter stating it will come out of next eob. I have spoken with our provider relations rep and sent in letter with corrected eobs, etc and bcbs of la will not take the refund check.
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participating?? I've only dealt with Par in this instance but I demand supervisor on the line. I don't send the check unless I have a name and documentation to indicate who I spoke with. As a former claims examiner myself we LOVED this because it was easier to back out claims/reprocess than it was to deduct from other claims (a lot more goes into than people think). We always took the refund as the preferred method to take care of an error like this. I have dealt with various state BCBS (Par only though) and never had a problem. I get the name of the person I spoke with and I get name to whom I was told to send the corrected claims and check to. When claims are received, if there is a check attached, that check is assigned the same batch claim number as the claim and is NOT given to the claims department. ONCE it's given batch number as accepted, the insurance carrier is libel to process it! IT Is NOT good practice to have overpayments adjusted to other patient's claims.
rdmoore2003:
I am par.
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