01/14/2022

Corrected Claim Submission to Medicare

If you realize a couple of months later that a mistake was made on your billing to Medicare i.e. billed 11721 instead of 11720, what is the best way to rectify that? And does that raise a red flag?

There is a way to make this correction to Medicare- if this is a single occurrence due to an accident or oversight, it will not cause a red flag. If it is done frequently, or if audits (pre or post payment) result in payment reduction or denial for the nail debridement because of insufficient documentation, that will cause issues in the future that will raise a red flag for claims processing. To correct the claim and downcode the service, a clerical reopening would need to be performed in one of three ways:

• Through the NGS Connex portal
• Completing a clerical reopening form and fax it to NGS Medicare for processing
• Calling customer service to complete a clerical reopening orally

To complete the request, you will need basic information about the billing provider (name, NPI, PTAN, and EIN) along with patient/encounter specific information (patient name, DOB, MBI, DOS, and ICN of the previously processed claim).