Claims that split due to diagnosis
Posted: Wed Aug 20, 2014 12:06 pm
Dear Gavin,
I am with Southwest Dermatology in Orland Park, IL. Ever since we have used Medisoft our claims split, finding this is because of different diagnosis. Since NGS took over Medicare this now has created a large problem for us!
We submit entire claim at the same time. The claim splits. Medicare processes the one that came through first and pays. They process the remaining line items and pay. Then they decide to do Audits. Because the other line items come in after the first, they assume its a new claim. Therefore they do an Overpayment Recovery.
When we receive the EOB from Medicare, the "Take Backs" are on the last page. The only information we are given is HIC number, Amount, and FCN number. We cannot always locate the patient by the HIC number. There is no date of service or CPT Code that they are taking this money from. When we call Medicare they can only provide us with "3" claims at a time. We then have to hang up, go through the automated process again, and resume with 3 more. I can't begin to tell you how frustrating and time consuming this has been to our practice.
Our vendor gave us a way to correct this in the patients ledger by taking out the diagnosis code, bill, then add the other in again. OMG! This does not work for our practice. We see over 100 patients per day and cannot go through each patient to do this! Not possible!
Please find a way to get the "Entire" Claim submitted at the same time using any diagnosis that we enter. This is also causing a problem because now the Secondary Insurance has paid as well. I can't imagine that we are the only practice in Illinois that uses Medisoft, having this problem.
Sincerely,
Lynn
Insurance Coordinator
Southwest Dermatology
I am with Southwest Dermatology in Orland Park, IL. Ever since we have used Medisoft our claims split, finding this is because of different diagnosis. Since NGS took over Medicare this now has created a large problem for us!
We submit entire claim at the same time. The claim splits. Medicare processes the one that came through first and pays. They process the remaining line items and pay. Then they decide to do Audits. Because the other line items come in after the first, they assume its a new claim. Therefore they do an Overpayment Recovery.
When we receive the EOB from Medicare, the "Take Backs" are on the last page. The only information we are given is HIC number, Amount, and FCN number. We cannot always locate the patient by the HIC number. There is no date of service or CPT Code that they are taking this money from. When we call Medicare they can only provide us with "3" claims at a time. We then have to hang up, go through the automated process again, and resume with 3 more. I can't begin to tell you how frustrating and time consuming this has been to our practice.
Our vendor gave us a way to correct this in the patients ledger by taking out the diagnosis code, bill, then add the other in again. OMG! This does not work for our practice. We see over 100 patients per day and cannot go through each patient to do this! Not possible!
Please find a way to get the "Entire" Claim submitted at the same time using any diagnosis that we enter. This is also causing a problem because now the Secondary Insurance has paid as well. I can't imagine that we are the only practice in Illinois that uses Medisoft, having this problem.
Sincerely,
Lynn
Insurance Coordinator
Southwest Dermatology