Re: CLAIMS SENT WITH WRONG DATE OF SERVICE

[Danni R.]

Palmetto GBA has a reopening phone line.  Once your claim has been processed (denied or paid incorrectly) and you want to make a change, like you forgot to put a modifier, or the date of service was not the correct one, all you have to do is call them and they make the correction and send out a new remittance advise with the corrected information.  So, if you were paid for the wrong DOS, you do not need to send in a refund check and then rebill with the correct DOS and then get paid for it.  It is all taken care of with the phone call.  All you have to do is wait for the claim to be processed before calling them.

On the other hand if there is an overpayment (you got paid for the visit twice, because I billed first with the incorrect date and then soon after with the correct date) you have to refund.

Thank you!!!! Good info.

[Pay_My_Claims]

A lot of offices don't realize too the importance of keeping a "paper" ledger style appt book too. When an audit is done the first thing looked at is the appointment book <g>
I always tell my clients that even if they are using a scheduling software to keep an appt book, it only takes a second to pencil someone in.

see we was all cool til now..........

[Danni R.]

A lot of offices don't realize too the importance of keeping a "paper" ledger style appt book too. When an audit is done the first thing looked at is the appointment book <g>
I always tell my clients that even if they are using a scheduling software to keep an appt book, it only takes a second to pencil someone in.

Oh, wow!!!! That's awesome advice. My instructors never mentioned this, neither the text books (but I will check!), and the doctors I worked for never stressed it (probably were unaware!). If I EVER go back to teaching again, I will make sure that is in my lessons.

[Danni R.]

That's not correct, maybe they have done it for you but it's not correct. Medicare nor any other carrier has authorization to "CHANGE" a date of service nor should they. The correct way is for another claim to be submitted. We don't ever want the carriers making correction to claims.. ever.  If the claim was electronic yes you can re-submit it and call them to let them know the correct date of service was submitted and to back out or adjust the previous incorrect claim.

See, I didn't know that either! It's not my field, but GOOD to know, period.

The same rule applies in a medical office to patient charts... you can correct an error, but ONLY by lining through the entry once, annotating it as an error, dating, and initialing it, then writing the correct data. NEVER EVER is white-out used in a patient chart/medical record, or black markers, nor are pages removed, thrown away, and rewritten and then reinserted. That's a BIG no-no. Those are official records and legal documents.

[Pay_My_Claims]

Yes, you have to submit a corrected claim, because they can't change it since it is a LEGAL document!

[Steve Verno]

Once Medicare finds out your mistake, if not corrected, they could
(a) come after you or your provider for double billing aka fraud and
(b) take back the extra payment
(c) audit you and the provider for other instances and maybe go more indepth and look for coding errors
(d)  issue sanctions for 5 years

[Danni R.]

THAT was a good question!!! Thank you Linda for also posting the answer. Who would have known?