Duplicate Medical Claims

When a medical claim is denied as a “duplicate” it means they have processed a claim for this specific medical service previously. It could mean one of the following:

• The claim was previously paid to the provider filing this claim
• The claim was denied for a specific reason and the claim was refiled with the same error
• Payment was made to another provider for this service
• Possibly the first claim filed was for only the professional or technical portion of the claim and was paid globally

When a medical claim is denied as a duplicate, it indicates that claim denial management is not working. The claim has to be reviewed in more than one way to determine the next course of action. First, you need to look at the original EOB you received, if you did receive an EOB. This should tell you why the claim was denied. It may not be specific but it will give you a direction to work from. Review the claim with the EOB Denial. If the answer isn’t clear, then the next course of action is to call the insurance company or payer of the claim. To get to talk to a person is time consuming, but often this is the main route to determining the problem and making a collection.

Some clinic management software systems promote the concept of refiling unpaid claims every 30 days. This usually results in leaving a lot of money on the table that the insurance company gets to keep.

This information provided by John Berven of MedQuest, Inc. More information can be obtained on request from by email to jabpfc@aol.com

Doctors Gold Mine Opportunity

The Deficite Reduction Act of 2005 has reduced payment for medical services to physicians, imaging centers and others billing their products or services to Medicare and or the insurance companies.  This has resulted in a reduction of income for many although they are as busy as ever.  Our audits of EOBs received by physicians and imaging centers indicates that over 25% of the claims filed are rejected or denied with no payment.   In addition, most clinics are too busy to spend sufficient time identifying the problems and or solving the problems.  This makes the doctors office and the denied claims an untapped gold mine for the doctor and his staff or the billing expert.  This is lost money that can be recovered but has a short time fuse. 

Gold Mine Opportunity   There is a opportunity in virtually every clinic and imaging center for recovery of denied claims.  The opportunity exists for the billing personnel as well as home based billing people. 

At your request, we will furnish you with additional information regarding our audits as no obligation if you email a request to us at www.docdoctordoc@aol.com  In the Subject Heading put ”Request for EOB Denial Information”