Q&A Correct Procedure for Med A Billing

[Kristi]

I work for a SNF( Skilled Nursing Facility). A coworker and I disagree on how to handle the scenario below:
Resident's payer sources are HMO A (Humana) and Medicaid. If after billing Humana for skilled days you then discover that the census was wrong for this resident and should have come off skilled the last 2 days of stay. Do you wait and see if Humana pays or do you send a corrected claim to Humana and then bill Medicaid for the 2 days of ICF? Is this an ethics or fraud dilemma? Please help!

 

[Alicia Scott]

In my opinion you need to correct the claim because if it is paid and incorrect it will still come back and bite you later. Send a corrected claim and bill Medicaid. This is when communication is important. Call Humana and let them know what is happening. Never fun to get bitten. Keep good documentation of what you are doing so that when you audited you show how you are proactive on mistakes like this.

 

[Kristi]

Thank you for your response! What you stated above is my side of the argument. I felt sure that this is the correct way to handle it. Unfortunaltely my coworker will not see this nor change the way things are done until forced by the powers that be. But thank you again for confirming.