Part B Insider (Multispecialty) Coding Alert

Avoid the need for appeals with this duplicate billing review.

Duplicate billing ranks amongst the top claims errors, creating problems system-wide that cripple the claims process. Oftentimes, providers do not realize that duplicate submissions have been sent to the MAC because they outsource their claims to a health care billing company, suggests Judy Brown, CPC, of NGS Medicare in an August 24, 2016 webinar.

Whether you are a provider, office manager, or coder, you need to understand the CMS minutiae surrounding duplicate billing in order to avoid an investigation. Here is a refresher quiz to see if you are up to speed.

Question 1:

What duplicate claims error message is most frequently associated with E/M services?

A. N20
B. M42
C. M86
D. N347

Question 2:

A patient comes into the office for tennis elbow and has an x-ray done. The radiologist sees something unusual in the x-ray and needs a second opinion. What modifier to you append to CPT^® code 73070 (Radiologic examination, elbow; 2 views) for the second x-ray and other physician’s interpretation?

A. Modifier 59
B. Modifier 77
C. Modifier 76
D. Modifier 25 

Question 3:

About how many days does it take for your MAC to review your duplicate claims through the Medicare Interactive Voice Response (IVR) telephone system?

A. 60 days
B. 14 days
C. 30 days
D. 5 days

Question 4:

If a claim is denied because it is considered a duplicate bill, but the reason it was denied was for a minor error, you might consider a _________ of the claim.

A. Resubmission
B. Redetermination
C. Reopening
D. Revocation

Question 5:

What do MACs not look at when they compare claims for duplicate submissions?

A. Place of service
B. Procedure Code
C. HIC number
D. Specialty

Question 6:

If you don’t hear back from your MAC on a duplicate claim, you should just keep resubmitting it until they respond.

A. True
B. False

Stay tuned. Be sure to read next week’s issue to check your answers. 

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