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Recovering Deny Medicaid Claims

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RCC:
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:
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:


--- 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.
--- End quote ---

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.

RCC:
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:
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.

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