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Americans Use Tax Refunds to Pay for Healthcare

As America scrambles to finish up filing their 2017 taxes ― due April 17 ― let’s look at where a big chunk of tax refunds are spent: deferred healthcare. Because of out-of-pocket expenses and high deductibles, people are waiting until after they receive tax payment back to have medical conditions, treatment, and procedures done. A JP Morgan […]
AAPC Knowledge Center

Tricare refunds due to invalid NDC

Someone familiar with Tricare billing: Please Help!

A few months ago, our practice began receiving multiple Tricare refund requests due to "the recommended drug/vaccine dosage for the National Drug Code (NDC) units from the manufacturer has been exceeded."

The claims listed were from 2013-2016 and totaled thousands of dollars. I was taught to report the NDC#’s as 5-4-2 format and each vaccine = 1 unit. Our software doesn’t support this so I have to manually enter these claims directly into MyTricare.com. I’ve contacted Tricare by phone and letter, but they only direct me to their online guidelines which appear to validate what myself, and the person before me, billed. When I called for help, I was told to refer to the FDA’s website because Tricare doesn’t have a list of vaccines and how they should be reported.

We have no choice but to refund this money, but I want to know what I’m doing wrong so this doesn’t happen again in another 3 years. Tricare is the only insurance that claims we are overbilling.

Thank you in advance to anyone who can help explain this to me.

Medical Billing and Coding Forum