What action is taken to alter a final determination regarding payment discrepancies?

The action taken to alter a final determination regarding payment discrepancies is referred to as reopening. Reopening is a process that allows a claim or determination to be revisited after a final decision has been made, typically due to new information or evidence that may affect the outcome. This is especially important in the context of medical billing and coding, where various factors may lead to payment discrepancies, and it provides a mechanism to correct errors or address concerns raised by providers or payers.

Reconsideration usually applies to a preliminary decision rather than a final determination, while an adjustment relates more to changes in the billed amount or payment amounts. A review typically involves assessing the current information without necessarily altering the final determination. Thus, reopening is the most appropriate course of action when there is a need to change a final payment decision based on new or revised information.