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Medicare Frowns on Duplicate Claim Submission

In a recent notification from Cahaba Government Benefit Administrators®, LLC,, the Medicare Administrative Contractor (MAC) for the states of Alabama, Georgia, and Tennessee, informed providers that the number of duplicate Medicare claims submitted is significant and improper.  Below is a statement included in this notification and a link to their article:

Unlike other health insurance payers where it is customary to bill until paid, multiple or repetitive billing to Medicare for a particular item or service is improper. Submitting more than one claim for the same item or service could cause a provider to be identified as an abusive biller, or, if a pattern of duplicate billing is identified, an investigation of potential fraud may be initiated. Please review the Medicare Learning Network article SE0415 found at titled “Reminder to Stop Duplicate Billing”.

The notice from Cahaba GBA goes on to explain what the major reasons for this large volume of duplicate claims and way providers can prevent the submission of duplicate claims. 

Some of the issues listed in this notification as contributing to a high volume of duplicate claims submissions included:

• provider’s billing software set to automatically re-file when claim is not paid

• Zero payment due to a denial or the allowed amount applied to the deductible on the original claim and the claim is resubmitted in an attempt to receive payment.

• provider who use a billing company that is paid per claim submission and may be automatically re-filing the provider’s claims.

Providers are encouraged to take steps to prevent duplicate claim denials by not using automatic rebill/refile features, checking Remittance Advices, responding to duplicate claim denials (CO18), and checking claim status before resubmitting a claim.  In addition, providers are reminded of the 14 day payment floor for electronic claims and asked not to automatically refile claims that are not paid after 30 days.