Quarterly Certs Review

NHIC and CMS continue to focus identification of provider compliance errors on duplicate claim denials. NHIC denied 4.00% of submitted claims as duplicates during the month of May 2007. Analysis indicates the following specialties as high volume duplicate submitters:

Specialty % of claim denials:

• Family Practice 7.08%
• Dermatology 5.14%
• Physical Therapist In Private Practice 5.00%
• Internal Medicine 4.84%
• Podiatry and/or Surgical Chiropody 3.94%
• Cardiology 3.91%
• Multiple Specialty Group 3.73%
• Ophthalmology 3.43%
• Diagnostic Radiology 3.24%
• Clinical Laboratory 2.21%

NHIC denied a total of $90,610,665 dollars due to duplicate claims during the month of May 2007. NHIC reminds providers that duplicate billing is not cost effective for the Medicare program.

Duplicate submissions are also the number one reason for poor provider compliance in the CERT review. Remember, duplicate billing is considered abusive and can result in additional auditing of your billing practice. Post your payments and denials to your records promptly. Review the reasons for denials and take the appropriate action. Check the IVR for payment information. Don’t automatically rebill services.