Tips on How to Avoid Billing a Duplicate Claim

Duplicate claim denials continue to be one of the top billing errors. Duplicate submission of Medicare claims cause an increase in cost, valuable time, and resources for the provider as well as Novitas Solutions.

A duplicate denial indicates more than one claim was submitted for the same service, for the same patient, for the same date of service by the same provider. In most instances, the claim was already processed and paid or it is an exact duplicate of a previously submitted claim.

Billing Tips

Review your medical record documentation to determine if a modifier is appropriate. Some examples include:

Use modifier 76 to indicate a procedure or service was repeated after the original procedure or service.
  • Report a narrative description indicating the reason for the repeat procedure in item 19 of the 1500 claim form or the EDI equivalent
Report modifier 59 to indicate a distinct procedural service:
  • This may represent a different session or patient encounter, different procedure or surgery, different site, or organ system, separate incision/excision, or separate injury (or area of injury in extensive injuries)
  • Bill all services performed on one day on the same claim
  • Report each service on a separate line
Do not report Modifier 59:
  • When another established, more descriptive modifier is available with an E/M service
  • If submitted with E/M codes 99201-99499
  • The E/M codes are processed as though a modifier were not present (i.e., the code pair is subject to CCI editing with an indicator that does not allow bypass.)
  • To report a separate and distinct E/M service with a non-E/M service performed on the same date
  • When a valid modifier exists to identify the services
  • When documentation does not support the separate and distinct status
  • When used to indicate multiple administration of injections of the same drug

Eliminate Duplicate Denials

Taking the following steps can help you eliminate receiving a duplicate denial:

  • Allow 30 days from the claim receipt date for the claim to process before resubmitting a subsequent claim for the same service(s)
  • Before submitting a new claim, check the Remittance Advice for the previously processed claim
  • Verify the reason the initial claim did not allow payment

Note: Many providers will refile a claim to correct a previously denied claim. This resubmission can cause an unnecessary duplicate denial when the initial claim processed correctly.

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Reed Tinsley, CPA