Don’t just resubmit to correct a denial. Submitting duplicate claims is a big mistake you don’t want to make in your practice. Provider outreach and education consultants Michelle Coleman, CPC, and Arlene Dunphy, CPC, from the Medicare Administrative Contractor (MAC) National Government Services (NGS), recently identified some ways you can avoid this mistake in the webinar “How to Avoid Duplicate Claim Denials.” Check out what these experts said so you can keep all your claims in tip-top shape. Avoid These Duplicate Claim Issues “When a claim comes into the system, we compare elements to identify an exact duplicate,” Coleman said. “When the claim comes into the front end, we’re looking at certain elements.” These elements include: When the claim comes in, if the system already has a claim that’s processed or is in process with the same elements, it’s either going to be held up, suspended, and require manual intervention or it will be denied as a duplicate, Coleman explained. Sidestep these issues: Submitting duplicate claims can cause several problems such as delaying payment, increasing administrative costs to Medicare, being identified as an abusive biller, or resulting in an investigation for fraud if a pattern of duplicate billing is identified, Coleman said. “We get a report once a month of the top 100 providers who have submitted the most duplicate claims,” according to Coleman. “We review the report, and if you are on that report, you could be getting a call from the provider outreach and education department. We try to work with the provider, and the majority of the time, it’s a system glitch the provider had no idea was happening. So, they can either go to their vendor or their clearinghouse and have the problem rectified.” However, Coleman added that if they see you are still submitting duplicate claims after the provider outreach department has spoken to you, you could be identified as an abusive biller and be investigated for fraud. Sidestep Denials With Expert Advice Coleman shared some helpful tips you can follow to avoid denials in your practice. Tip 1: Check your remittance advice for the previously posted claim. Tip 2: Verify the reason the initial claim was denied. Tip 3: Don’t just resubmit to correct a denial. Tip 4: Use the interactive voice response (IVR) or NGSConnex to check on current claim status. Tip 5: Allow 30 days from the receipt date. Tip 6: Make sure your billing service/clearinghouse is waiting the appropriate time frame. Check Out How to Use Repeat Modifiers Correctly When you are submitting claims for multiple instances of services or procedures, your claims should include an appropriate modifier to indicate that the service or procedure is not a duplicate, Dunphy said. You will accomplish this by using a modifier depending upon your case and what you’re billing for because that’s what is going to allow your claim to go through the system, get processed, and be paid, Dunphy added. Take a look at some common repeat modifiers you might see: Modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) Appropriate uses for modifier 76: Inappropriate uses for modifier 76: Modifier 77: (Repeat procedure by another physician or other qualified health care professional) Appropriate uses for modifier 77: Inappropriate uses for modifier 77: Modifier 91: (Repeat clinical diagnostic laboratory test) Appropriate use for modifier 91: It is appropriate to use modifier 91 for a subsequent medically necessary laboratory test on the same day of the same laboratory test. Inappropriate uses for modifier 91: