Q: Can a doctor recode and bill insurance after receiving a denial claim?
A patient was seen as a new Medicare wellness visit but had previously had one within the year by another physician unbeknownst to the office. So the claim was denied and the Dr. Wants to recode and resubmit.
A: In New York, a doctor generally can recode and resubmit a claim to insurance if the original claim was denied. However, the recoding must accurately reflect the services provided, and the practice could be subject to audit. Additionally, Medicare has specific rules and timelines for resubmitting claims.
Tim Akpinar agrees with this answer
A: They generally can. I'm not certain of the specific rules for Medicare billing, but in just about all forms of insurance for health care claims, examiners can delay claims for CPT coding errors and allow a medical office to resubmit claims with the proper codes. It also depends on the circumstances of the denial or delay - it can be claim-specific. If it's things like duplicate services, fee schedule errors, etc., some things won't be corrected by applying different coding. Good luck
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