Duplicate Claims in Medical Billing | Duplicate Service (2024)

FAQs

How to handle duplicate claims? ›

As soon as you notice a duplicate claim, you should notify the patient's insurance company to avoid professional and legal repercussions. For example, if a clinic double bills a patient and doesn't reverse the charges quickly enough, it could be subject to an FBI investigation for health care fraud.

Submitting an exact duplicate claim or service: This occurs when a healthcare provider accidentally submits the same claim or service multiple times. It can happen due to human error or system glitches.

If separate claims are submitted for the same beneficiary on the same day with the same ZIP code, and you bill them on separate claims, the second claim could deny as an exact duplicate. Bill both transports together on the same claim to avoid this duplicate denial from occurring.

What is denial code CO 18? Before trying to overturn any type of denial, you need to understand what it is. Denial code CO 18 means, “exact duplicate claims or services.”

Duplicate claims are any claims paid across more than one claim number for the same beneficiary, CPT/HCPCS code and service state by the same provider. Affected Code(s) All CPT, HCPCS codes.

CPT Modifier 76: 'Repeat procedure by same physician: The physician may need to indicate that a service was repeated the same day subsequent to the original service. This modifier indicates the difference between duplicate services and repeated services.

Duplicate Service means a Service operated by a Bus Operator that runs an identical route to another Service of the same Operator concurrently to help reduce delays on that route.

Using the GROUP BY clause to group all rows by the target column(s) – i.e. the column(s) you want to check for duplicate values on. Use the COUNT function in the HAVING clause to check if any of the groups have more than 1 entry; those would be the duplicate values.

What modifier is used for repeat procedure? ›

Modifier -76: Used to indicate that a procedure or service was repeated subsequent to the original procedure or service by the same provider ID on for the same member on the same date of service or within the post-operative period.

If duplicate records are not removed, then data processing will fail. The purpose of this control is to remove multiple instances of records in order to prepare the dataset for additional processing.

In some cases where a claim is denied because the clinic or hospital sent it to the insurer too late, the clinic or hospital may turn to the patient for payment.

Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circ*mstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”

Same Loss Cannot Be Claimed Twice Over.

While you cannot file multiple claims against the same party or provider, you can file multiple suits after an auto accident if multiple parties were at fault or if multiple insurance companies maintain coverage or may be responsible, and you suffered injuries or damages as a result.

As a starting principle, an insured cannot profit from their loss or make a claim twice. However, where a policyholder is insured by multiple policies, they can choose which policy they wish to claim under.

False Claims Act [31 U.S.C.

Filing false claims may result in fines of up to three times the programs' loss plus $11,000 per claim filed.