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May 2, 2022

ATTN: Billing Services! Part B Reopenings Reminders!

When submitted correctly Part B Reopenings are automated, which significantly reduces the amount of time they take to process. In order for automation to work Reopenings must be submitted correctly.

We are noticing an increase in Reopenings submitted through billing services that are either incorrect, incomplete, or submitted in such a way that causes unnecessary work and delays in processing and adjustment to you.

Submit a Reopening when a claim that was either paid or denied was processed with minor errors or omissions. Examples include:

  • Date of service correction (within the same year) that do not result in an overpayment
  • Place of service corrections/changes
  • Fixing a transposed CPT/HCPCS code
  • Correcting the number of services (Units)
  • Diagnosis code changes
  • Add, change, or remove some modifiers
  • Correct the billed amount

The most efficient way to submit Reopenings is through myCGS.

Below, are several examples requests we’ve received from billing services.

  • Sending requests to cancel an entire claim or line of a claim when the only change needed is to correct a procedure code.
    • Once a claim/line is canceled we can no longer make changes to that claim/line.
    • Canceling instead of correcting also results in unnecessary recoupments of paid claims/services.
    • Doing this causes further delays, as the request has to be transferred to Overpayment Recovery OR a letter is returned, and no changes are processed. Overpayments can also result in having to file Appeals instead of simply making the initial corrections as needed.
    • Be sure you select the correct option.
  • Sending multiple requests for the same claim – sometimes 10 in the same day – which results in one being processed and the remaining requests slowing down response time.
    • Be sure to track Reopening requests to avoid sending duplicates. Reopenings can take up to 60 days to process.
    • Check the status of submissions before resubmitting another request. (NOTE: If you submit Reopenings through myCGS you can track its status!)
  • Multiple requests to “reprocess claim” for the same claim, which result in one adjustment, then another, then another…
    • The claim will not process a different way unless there is an update in the billing history, a correction placed on the claim, or a fee schedule change. This happens most often with Evaluation & Management (E/M) services.
  • Requests received that cannot be found in our system, which results in no response to you.
    • This happens when the original claims are processed by other contractors. Please verify requests sent to reopen claims are for claims we’ve processed.
  • In some cases, Reopening requests should be sent as a Redeterminations (1st level of the appeals process.)
    • The requests ages in the Reopenings workload and is eventually transferred to the Redeterminations workload, resulting in even more delays.
    • Use the Part B Appeals Decision Tree for help determining the correct workload.
  • Claims/services that are rejected with an MA130 message code cannot be reopened.
    • MA130 indicates the claim/service has billing errors and cannot process in our system.
    • Check to make sure Reopenings are sent for claims/services that have processed (paid or denied), not rejected.

Please be sure to share this information with your billing services.

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