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Recovering Deny Medicaid Claims

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Merry:
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:
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:
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.

PMRNC:
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.

Merry:
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

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