bower
New
Hello, I have a doctor who wants to split up cpt codes(both from the same dos) on to two different claim forms, is there anyone that can provide a link on this topic indicating this is fraud?
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Wiki Split Claims
- Thread starter bower
- Start date
mitchellde
True Blue
There is nothing to be gained from this. One claim will be declined as a duplicate claim. why is the provider wanting to do this?
CodingKing
True Blue
There is not really a lot of information out there that talks about splitting claims, however Fraud is an intentional deception or misrepresentation of fact that can result in unauthorized benefit or payment.
I cant think of any reason to split claims that wouldn't qualify as deception or misrepresentation to obtain unauthorized payment.
I cant think of any reason to split claims that wouldn't qualify as deception or misrepresentation to obtain unauthorized payment.
MzOptimistic
Contributor
The only time I split claims at work is when ER and Inpatient charges were billed on one claim. I split the claim so the ER charge can be on a separate claim.
jlbaker10
New
I worked for a DME provider for many years and splitting claims was often necessary. (Keep in mind though, I was billing HCPCs not CPT.)
Some examples:
A patient gets a wheelchair and a hospital bed on the same DOS. About 90% of (Medicare) claims for hospital beds go through a pre-payment audit. If the wheelchair and the bed are on the same claim, then payment for the wheelchair gets postponed until the audit for the bed is completed.
A patient gets a replacement CPAP at the same time as he gets replacement CPAP supplies. The machine gets audited and, again, your supplies get hung up on the audit.
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I called Medicare at one point, to ask about the payment being held up for the wheelchair and it was actually her suggestion that we split the claims, however, if you have had any experience with Medicare, you know that you often get a different answer each time you call. It used to make me crazy when CS would forget to split those claims, because you can't undo it and it would make our aging all wonky.
Some examples:
A patient gets a wheelchair and a hospital bed on the same DOS. About 90% of (Medicare) claims for hospital beds go through a pre-payment audit. If the wheelchair and the bed are on the same claim, then payment for the wheelchair gets postponed until the audit for the bed is completed.
A patient gets a replacement CPAP at the same time as he gets replacement CPAP supplies. The machine gets audited and, again, your supplies get hung up on the audit.
-
I called Medicare at one point, to ask about the payment being held up for the wheelchair and it was actually her suggestion that we split the claims, however, if you have had any experience with Medicare, you know that you often get a different answer each time you call. It used to make me crazy when CS would forget to split those claims, because you can't undo it and it would make our aging all wonky.
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