Billing Issue
Can anyone help me understand a billing issue?
We have a fair number of cases where the DRG changes after the initial
claim has already been submitted. My understanding is this: A revised
higher-weighted DRG can only be submitted within 60 days of the original
claim date, but a revised lower-weighted DRG can be submitted after the
original claim with no time limit. Is this correct?
What are the implications of resubmitting a DRG claim? Is such a claim
automatically audited? If so, who audits it? Do they request the record
for a complex review? How does a pattern of rebilling DRG's get noticed?
What happens if and when it is noticed?
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
149 North Street
Waterville, ME 04901
Phone (207) 872-1796
Fax (207) 872-1519
Cathy.Seluke@mainegeneral.org
"That's why erasers were put on pencils."
--Robert Lovely c. 1960 when asked if he ever made
mistakes
We have a fair number of cases where the DRG changes after the initial
claim has already been submitted. My understanding is this: A revised
higher-weighted DRG can only be submitted within 60 days of the original
claim date, but a revised lower-weighted DRG can be submitted after the
original claim with no time limit. Is this correct?
What are the implications of resubmitting a DRG claim? Is such a claim
automatically audited? If so, who audits it? Do they request the record
for a complex review? How does a pattern of rebilling DRG's get noticed?
What happens if and when it is noticed?
Cathy Seluke, RN, BSN, ACM, CCDS
Supervisor Clinical Documentation Compliance
MaineGeneral Medical Center
149 North Street
Waterville, ME 04901
Phone (207) 872-1796
Fax (207) 872-1519
Cathy.Seluke@mainegeneral.org
"That's why erasers were put on pencils."
--Robert Lovely c. 1960 when asked if he ever made
mistakes