Reopenings Based on Clerical or Minor Errors and Omissions

10.4 - Reopenings Based on Clerical or Minor Errors and Omissions (Rev. 3568, Issued: 07-29-16, Effective: 09-30-16, Implementation: 09-30-16) Section 937 of the Medicare Modernization Act (MMA) required CMS to establish a process, separate from appeals, whereby providers, physicians and suppliers could correct minor errors or omissions. We equate the MMA’s minor error or omission to fall under our definition of clerical error, located in 42 CFR 405.980(a)(3). We believe that it is neither cost efficient nor necessary for contractors to correct clerical errors through the appeal process. Thus, 42 CFR 405.927 and 405.980(a)(3) require that clerical errors be processed as reopenings rather than appeals. CMS defines clerical errors (including minor errors or omissions) as human or mechanical errors on the part of the party or the contractor, such as: • Mathematical or computational mistakes; • Transposed procedure or diagnostic codes; • Inaccurate data entry; • Misapplication of a fee schedule; • Computer errors; or, • Denial of claims as duplicates which the party believes were incorrectly identified as a duplicate. • Incorrect data items, such as provider number, use of a modifier or date of service. Note that clerical errors or minor errors are limited to errors in form and content, and that omissions do not include failure to bill for certain items or services. A contractor shall not grant a reopening to add items or services that were not previously billed, with the exception of a few limited items that cannot be filed on a claim alone (e.g., G0369, G0370, G0371 and G0374). Third party payer errors do not constitute clerical errors. The law provides that reopenings may be done to correct minor errors or omissions, that is, clerical errors. The contractor has discretion in determining what meets this definition and therefore, what could be corrected through a reopening.