6 ways to stop filing duplicate Medicare claims - Duplicates could expose your practice to fraud investigation

by 
January 6th, 2016

By: Scott Kraft (Dec/04/2013) 

Whenever a Medicare Administrative Contractor (MAC) releases a list of the top reasons for claims denials, the list almost never fails to include duplicate claims. 

When the MAC perceives the claim to be a duplicate, based typically on a match of the patient identifying information, furnishing provider, date of service and billed codes, processing of the service is going to be stopped cold. You’ll see CO18 on the remittance advice, which is the code for a duplicate claim.

Providers typically don’t intend to re-bill the same service, but the MACs and CMS alike have expressed their frustration with the clogging of the processing system with duplicates. To put it in perspective, in one quarter alone in 2010, Cahaba received 489,738 duplicate claims in Alabama, Georgia, Mississippi and Tennessee.

Filing a lot of duplicate claims exposes you to some risk, as the MAC can see you as either an abusive biller or unfocused on provider education. At the worst, your practice could leave a perception that it’s trying to game the system.

Here are some causes of duplicate claims and ways to solve them:

References:

6 ways to stop filing duplicate Medicare claims - Duplicates could expose your practice to fraud investigation. (2016, January 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/6-ways-to-stop-filing-duplicate-medicare-claims-duplicates-could-expose-your-practice-to-fraud-investigation-28047.html

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