Reopening Denied Medicare Claims
Sometimes your claims get denied for minor errors or omissions. Understanding how to reopen these claims efficiently can save you time and improve the health of your business. In this article, we'll outline the process for reopening denied Medicare claims.
What You Need to Know
If your claim has been denied due to a minor error or omission you do not have to go through the full Medicare appeals process. Instead, you can request a reopening to correct the mistake. You can do this either by telephone or in writing within one year from the date on your Remittance Advice (RA). Minor errors or omissions that you can correct through the reopening process include:
- Mathematical or computational mistakes;
- Transposed procedure or diagnostic codes;
- Inaccurate data entry;
- Misapplication of a fee schedule;
- Computer errors;
- Incorrect data items, such as modifiers or service dates; and
- Claims denied for being filed after the claim filing time limit.
On the other hand, the following issues cannot be addressed through the reopening process:
- Claims denied as not medically necessary;
- Unprocessable claims;
- Modifier issues (KX, GA, GY, GW, GZ);
- Status inquiries;
- Claims audited by external entities (e.g., RAC, UPIC, CERT);
- Targeted Probe and Educate audits;
- Corrected PTANS; and
- Recoupment requests that should be submitted to overpayment recovery.
What this Means for You
Understanding and utilizing the reopening process for minor errors can significantly streamline your claim corrections and improve your practice's efficiency. Make sure that you understand the difference between the kinds of errors that are subject to reopening and those that are not.
- For information about how to reopen claims submitted to Region A (Noridian), click here.
- For information about how to reopen claims submitted to Region B (CGS), click here.
- For information about how to reopen claims submitted to Region C (CGS), click here.
- For information about how to reopen claims submitted to Region D (Noridian), click here.
Be aware that based on the complexity of a given submission, the DME MACs have the right to decline your clerical error reopening request. In those instances, the MACs will instruct you to instead submit a redetermination request.