National Government Services (NGS), the Jurisdiction B DME MAC, has advised DME suppliers to avoid submitting duplicate claims, defined as “paper and electronic claims…for the same beneficiary for the same item or service for the same date of service.”
NGS noted that for the first three months of 2008, duplicate claims made up 29 percent of all claim submission errors. Duplicate denials made up nearly 15 percent of all denied claims, and NGS said it processed more than 94,000 duplicate claims in the first quarter of 2008.
Noting that duplicate claims “result in unnecessary costs to the Medicare program and a waste of trust fund and tax payer dollars,” NGS also warned that a pattern of duplicate billing “may generate a fraud investigation.”
To avoid inadvertently submitting duplicate claims, NGS suggested that electronic submitters check software systems to “verify that your claims’ software system is not set up to automatically rebill every 30 days or at any other set time intervals” and to contact the software vendor if suppliers receive duplicate claim denial rejections, but weren’t aware duplicate billing was taking place.
NGS suggested electronic and paper submitters access the interactive voice response system to determine if a claim has been denied as a duplicate, and to ensure that billing staffs know “Medicare payment floors and claims filing rules.”
