Forum - Questions & Answers

May 11th, 2015 - kjstremont1 7 

ESRD diagnosis Medicare advantage plan requests refund

Help! We have a Medicare patient who saw our family practice provider. They have ESRD & are currently on dialysis, but that is not why we saw the patient. The Medicare advantage plan is asking for a refund on a claim from a year ago due to the diagnosis of ESRD (4th diagnosis on the claim). Why should they get a refund & who is supposed to pay?
Thanks for your help!

May 11th, 2015 - petunia 195 

re: ESRD diagnosis Medicare advantage plan requests refund

If the patient was not seen for ESRD, but the dx was used and that is why they want to money back appeal it with the notes for the service and let them know the dx was used in error and should be removed. You still have appeal rights when they are asking for the money back.

May 11th, 2015 - kjstremont1 7 

re: ESRD diagnosis Medicare advantage plan requests refund

Thank you. Our physician mentioned that the patient needs to follow up with the specialist for the ESRD & Humana Medicare always wants all dx listed on the claim, so we listed this as the 4th dx. If that dx causes issues, we will stop including it on the claim! I wasn't aware that it would cause a problem!



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association