Provided by:  Jennifer Kirschenbaum, Esq.

January 28, 2019

 

Question: 

 
Hi Jennifer,

I realized one of my providers has been systemically under-coding.  Can I resubmit claims with proper codes?  The claims in question are already processed.  Thoughts? 

Dr. G
 
 

Answer:

 
I'm honestly not sure how you would have justification for doing so, or not create a logistical nightmare on this one.  Here you would need a reimbursement adjustment, and you say its a systemic issue, so assuming we are talking a lot of claims.  I am happy to open this one to your colleagues and the experts on this chain, and publish results.  My take - you would likely have to refund the money, somehow resubmit with amendment note, NOT amended note with no contemporaneous signature and current date documenting any changes made to anything previously documented or submitted.  

My vote - ship has likely sailed....