Submit a Lot of Duplicate Claims? Expect a Call
- By admin aapc
- In CMS
- January 29, 2010
- 3 Comments
Medicare Administrative Contractor (MAC) National Government Services (NGS) is in the process of identifying providers in jurisdiction 13 (Connecticut and New York) who continually submit multiple duplicate claims. These providers will be asked to explain the reason(s) for the duplicative billing and education will be provided to avoid excessive submissions in the future.
NGS does not believe offending providers are deliberately trying to defraud Medicare, but habitually submitting multiple duplicate claims does send out a red flag.
The definition of a duplicate claim submission is when a provider resubmits a claim either on paper or electronically for a single encounter and the service is provided by the same provider to the:
- same beneficiary; for the
- same item(s) or service(s); for the
- same date(s) of service.
You can identify claims that are denied as a duplicate submission by reviewing your remittance advice (RA). Your RA will provide you with the American National Standard Institute (ANSI) group code “CO” and reason code “18.” NGS recommends providers check claim status.
For information on the status of a claim submitted to NGS and/or to verify NGS received your claim, you should follow the instructions provided on the company website.
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Resubmitting the claims without paying attention as to why the claim got denied at the first place is not going to get the claim processed any faster. Understand the reason of denial on the original claim; if reason code is not clear, speak to a representative and get a clear picture of the denial. Some of the payers like Medicare , Railroad Medicare have a dedicated reopening unit, small fixes like data entry errors like missing modifiers or wrong DOS, or no. of units not billed correctly can easily be fixed by calling them.
Navinet has a very nice feature called claim reconsideration, where you can request the claim to be sent for reconsideration if you feel they have denied it in error without the need to resubmit the claims multiple times.
I understand the issue of duplicate claim submisson. It would be of great help if the payor would not give the provider the wrong information during claim follow. I personally have been following up on my claims to get told by the payor “No Claim On File”, did you submit the claim electronically I am asked, yes, I say then am told to re-submit the claim by paper. In which I do submitt the claim by paper to receive an EOB for duplicate claims submission!!!!! So maybe all providers are not looking to deceive Medicare or commercial payors, maybe Medicare along with all payors should look internally and review the recorded phone conversations of their Customer Service Representatives who are giving incorrect information to the providers who are submitting duplicate claims. I for one do not appreciate paying for electronic claim submission to turn around and pay for a paper claim submission for the one patient I am trying to get paid on, when I would not have submitted a duplicate claim if I had beeen given the correct information in the first place when I called the payor to see if my claim was there and was in processing!