Do you have to reverse a claim if the sig is typed wrong?

[justjoe]

For retail pharmacy:

I have always reversed and resubmitted claims if anything was entered incorrectly, except the sig. If the sig was entered incorrectly, I just change it without reversing it.

Does the insurance company "see" the sig that you send with the claim?

Thanks!

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[JustAnotherRph]

in both claims processors I work with, we don't see the sig. We only see the quantity submitted and days supply, along with other claim information.

 

[croquemonsieur]

woops what do?

 

[owlegrad]

I have to cancel a script in order to change the sig after it has been adjudicated. I would guess that if your system allows you to change it after billing that it is fine to do so.

 

[ornithoptor]

It is all fine until you are audited by a third party. I would not worry about most of cheap meds. However, for expensive drugs and ointment and cream, I would make sure the sig is EXACTLY the way was written. Auditors are paid to find these mistakes. They WILL match hardcopy with label.
Hope this helps.


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[rcodyfb16]

It is all fine until you are audited by a third party. I would not worry about most of cheap meds. However, for expensive drugs and ointment and cream, I would make sure the sig is EXACTLY the way was written. Auditors are paid to find these mistakes. They WILL match hardcopy with label.
Hope this helps.


Sent from my iPad using SDN mobile

In the situation being described it would seem like the hard copy would match the label. Just not what was initially submitted to insurance. If they cant see the sig and only see day supply and quantity, then I don't think they would be able to determine if it had been changed after the fact.

 

[farmadiazepine]

Reverse it, correct it, and resubmit it if you do not want the money for the claim to be recaptured by the insurance company.

Two years ago we had an auditor come into our store and he audited a brand Seroquel 200mg prescription. The directions on the prescription were "Take 1 to 2 tablets every day at bedtime", however, we wrote "Take 2 tablets every day at bedtime". The insurance company took back all the money for that claim.

It took us a while to fight it, and eventually we got a new prescription and a signed letter from the physician saying he wanted the patient to take 2 tablets at bedtime. It was a huge, unnecessary headache.

Insurance companies go for technicalities, and different directions on the prescription versus what was submitted will be a reason they recapture a claim.

We had insurance companies try to get back money because OxyContin scripts which we dispensed as BID were written as Q12. They wanted us to write every 12 hours. We also had companies try to take back money because did not write where fentanyl patches were being applied. The auditor said we were supposed to write "Apply 1 patch to acute chest well every 72 hours" instead of "Apply 1 patch every 72 hours".

Directions matter if you want to keep the money for the claim. I wouldn't bother with cheap drugs, but anything over $100, you bet I will reverse, correct, and resubmit.

 

[Amicable Angora]

This reminds me of that lawsuit that woman won who spilled McDonald's coffee all over herself and claimed she didn't know coffee was hot.

 

[RxPreceptor]

Hmm no mention of removing fentanyl patch after 48-72 hours...denied. Did not put remove foil before inserting suppository...denied.

More pencil pusher bull****. There's only so many characters that can go into sigs. I would like to throw a thesaurus & a hardback goodman & Gilman's at an auditor's head

 

[Old Timer]

This reminds me of that lawsuit that woman won who spilled McDonald's coffee all over herself and claimed she didn't know coffee was hot.

You know this is a complete and total lie. It's as truthful as the crap Sean Hannity spouts about the Seth Rich's murder. If you don't know the truth don't speak. Better to be silent and thought a fool than open your mouth and remove all doubt.

First of all, the lady did not want to sue McDonalds. She only asked to cover her medical expenses. They offered $800.00. At trial the plaintiffs attorney was able to establish:

The coffee industry recommended coffee be heated to a lower temperature than McDonalds heated their coffee.
McDonalds specifically instructed their franchises to heat the coffee to 180-190 degrees.
McDonalds knew coffee at that temperature could cause 3rd degree burns that would require skin grafting and already had 700 reports of sever burns from their coffee and had already paid out $500,000.00 to settle claims
McDonalds admitted in court that if consumed at that temperature it would burn the mouth.

So, not only did they sell a dangerous product they had a chance to settle the claim for medical expenses only and were too stupid to do it.......

 

[Old Timer]

It depends on your software. The third party will never look at the directions that you put on the label. It is not part of the NCPDP claim submission record. It's qty and days supply that have to do with directions.

 

[Amicable Angora]

You know this is a complete and total lie. It's as truthful as the crap Sean Hannity spouts about the Seth Rich's murder. If you don't know the truth don't speak. Better to be silent and thought a fool than open your mouth and remove all doubt.

First of all, the lady did not want to sue McDonalds. She only asked to cover her medical expenses. They offered $800.00. At trial the plaintiffs attorney was able to establish:

The coffee industry recommended coffee be heated to a lower temperature than McDonalds heated their coffee.
McDonalds specifically instructed their franchises to heat the coffee to 180-190 degrees.
McDonalds knew coffee at that temperature could cause 3rd degree burns that would require skin grafting and already had 700 reports of sever burns from their coffee and had already paid out $500,000.00 to settle claims
McDonalds admitted in court that if consumed at that temperature it would burn the mouth.

So, not only did they sell a dangerous product they had a chance to settle the claim for medical expenses only and were too stupid to do it.......

Well, thank you for the truth.