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Was Your Claim Denied as a Duplicate Service?

Every practice, on occasion (if not more often) receives a denied claim notification that states the service has been denied as a duplicate. When the insurance denies a service as duplicate but your records indicate this is not true, how should you act?

Review the record to verify that the service rendered was actually performed and billed just once. If the service has been performed and billed only once, then contacting the insurance company and reviewing the claim with a claims specialist may be the best option.

Duplicate service denial is indicated when the same service was performed on the same patient on the same date and by the same provider.

Three reasons a claim may be denied as duplicate:

1. The service was performed more than once on the same day validating the denial.
2. The service was performed once but billed twice.
3. Another physician performed the same service on the same date and submitted a claim with the same CPT code you did, which was processed prior to your claim.

How to respond to a claim denied as a duplciate:

1. If the service was performed more than once on the same day it may be eligible for a modifier. Modifier 50 or RT and LT modifiers appended would indicate the same procedure performed bilaterally and may clear up the confusion. If it was performed more than once during the same day and by the same provider, you may need to append modifier 76 and rebill. If you had already done that and it still denied simply submit a letter of appeal with a copy of each report for that specific service for proof it was performed more than once and therefore is not a duplicate service.

2. If you find you have actually submitted the claim twice then you may need to verify a few things:

• Was payment made on the first claim and if yes, was it sent to the correct address?
• Has the check been deposited and somehow missed in the posting process?
• Was the payment sent to the patient for failure to check the 'accept assignment' box on the HCFA form?
• Was the first claim submitted denied? If denied, was the denial handled correctly? Some insurances will allow you to simply correct a diagnosis code, modifier, or other problem and simply resubmit the claim.

Some insurances will deny the claim if it is resubmitted with the changes instead of appealed. Be sure you understand the claim resubmission policy for each insurance you are contracted with.

3. If another provider has performed the same service and was paid while your claim was denied you may need to speak to your insurance representative to determine the proper method of appeal required by the insurance. Methods of appeal may vary by insurance.

In short, a denial for duplicate service does not mean the claim will never be paid. Do a little research and see if any of the scenarios above fit your particular situation and then act accordingly.

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Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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