Mistakes happen.
When a provider accidentally submits an original bill that contains an error, taking the appropriate action is key to avoiding further delay in reimbursement. Often, providers attempt to submit revised or corrected bills, rather than waiting to submit a second review appeal.
Theoretically, submitting a corrected bill can seem like the appropriate option in some situations. In reality, the process of re-submitting a corrected bill is undermined by poorly constructed regulations, and is completely unreliable — even pointless.
Rather than submitting a corrected bill, there are two (much better) options, depending on the nature of the error:
Yes, there is a bill correction process. However, the two options above are simpler, and far more likely to result in proper reimbursement.
California billing regulations allow a provider to submit a revised bill as long as both of the following conditions are true:
The provider cannot possibly know the status of whether the claims administrator has sent the EOR, or is on the verge of doing so. This means that claims administrators might receive the revised bill after sending the EOR. If the claims administrator receives the revised bill after sending the EOR, the revised bill may be incorrectly treated as a duplicate or as a Second Review appeal
The DWC Medical Billing and Payment Guide outlines the process for submitting revised non-electronic bills, and the Electronic Billing and Payment Companion Guide outlines said procedure for electronic bills.
These Guides contradict each other. Section 5.0(b) of the Medical Billing and Payment Guide states:
Meanwhile, the field tables for the CMS-1500 and UB04 billing forms — found in the same Medical Billing and Payment Guide — note the following under the fields for condition codes:
Huh? Come again?
Even if condition codes are applicable to revised non-electronic bills (and frankly, who knows if they are?), which condition code would it be? The condition codes W2 through W5 represent duplicate bills and varying levels of appeal, not revision or correction.
Our advice? Don’t bother.
Again, to bill for missing procedure codes or units, just submit another bill. Otherwise, follow the second review appeal process:
Of course, if Second Review fails to produce the correct reimbursement, providers have options. Request Independent Bill Review to resolve disputes over reimbursement, or if necessary, file a lien to resolve liability disputes.
Even after making a mistake, providers deserve correct reimbursement. Sadly, the established process for correcting mistakes via resubmission is a mistake unto itself.
Proceed accordingly.
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