Handling Denials for Duplicate Service

It is not unusual at all to receive a denial stating that the claim you sent is being denied as a duplicate but you have no record of receiving payment for that service. There are many reasons this can happen. Often billers don’t know what to do about such a denial. Here is what to consider.
First is the claim being billed by a billing service or in a medical office by the staff? In our situation as a billing service the first possibility is that the claim was processed but the eob was not passed on to the billing service so the claim was resubmitted.
The second claim was then denied as a duplicate. We have had situations where offices that didn’t realize they should forward an eob if a payment was not made. Sometimes it is just overlooked by the person in charge of forwarding payment notices. We have also had occasion when faxes failed or came through blank that were eobs.
The next possibility is that you have entered the claim twice in error. We have had offices send us duplicate dates of service and it go unnoticed and the claims were submitted on two separate billings. Our processors try to catch these, but occasionally one will slip through.
Another possibility is that the insurance carrier made an error. Every once in awhile we get an eob for a claim denied as a duplicate when it was only submitted once. Sometimes the claim will hit up against another claim for a different provider and a different service on the same date. It isn’t a true duplicate, but the computer system thought it was and denied it automatically.
So the obvious question is how do you handle each of these possibilities. In the case of the claim being resubmitted by a billing service and denied as a duplicate, the first thing you should do is make sure the claim isn’t entered twice. In a situation where a patient comes in repeatedly as in the case of counseling or chiropractic, it is not uncommon for more than one date of service to go on a claim. You want to check any billings where multiple dates of service were sent in that time frame.
If it wasn’t, look to see if it was submitted twice and payment came in before the second submission was processed. In either of these situations, it truly is a duplicate and the claim was denied correctly. You don’t need to do anything except review your process to see if you could eliminate this in the future. If it does not appear to be previously paid then the best way to handle it is to check with the insurance carrier and find out what happened the first time the claim was processed. When was it processed and what was the outcome?
If it was paid previously you should make sure the check was received and cashed by the provider. If it was and this is a common happening with this particular provider, you need to explain to them the importance of getting a copy of the eobs when they come in. It is a great waste of time to be tracking processed claims and a trigger for fraud with the insurance carriers.
If you find that you have submitted the claim on two separate billings and this has been happening frequently with a particular provider, you need to be more careful and check when entering new claims to see if these claims have already been submitted and find a system to prevent this duplicate billing. We have one mental health provider who faxes us and also mails to us. He often sends us claims in the mail that were previously faxes and already submitted. We now check all claims he sends to make sure we haven’t sent them already. We find this saves us a lot of work in the long run.
The important thing is that when you get a denial for duplicate claims, you have a system for handling it. You shouldn’t just assume that the denial is correct and ignore it. You need to investigate, determine if the claim was previously paid and paid correctly, and why the claim was resubmitted to avoid this in the future and to ensure your provider gets payment for all services.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s