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Coding Tips for the Young Ophthalmologist
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One way of attracting unwanted audit attention is duplicate claim submissions. A duplicate claim is defined as a claim submitted to Medicare from the same provider, for the same beneficiary, for the same item or service, for the same date of service.

Based on data analysis, one Medicare payer reported 489,738 duplicate Part B claims received in the first quarter of 2010.

undefined For example: physician submits 92136-RT, but neglects to list the “referring/ordering physician.” The claim is denied. Instead of listing the ordering physician’s NPI, the claim is resubmitted numerous times with the same mistake.

Submitting claims with the same coding error could cause a physician to be identified as an abusive biller, or if a pattern of duplicate billing is identified, an investigation of potential fraud may be initiated.

Take-home message: When a claim is denied, review the denial reason then make appropriate correction before submitting the claim again.

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For even more coding advice and a host of other benefits, join the American Academy of Ophthalmic Executives, the Academy’s practice management arm. Membership is FREE for residents and physicians in their first year of practice, and discounted for physicians in their second year of practice. As an AAOE member, you would get two free, personalized answers to your coding questions each year, in addition to all the other benefits of membership.

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About the author: This article has been adapted from the June 2010 issue of Coding Bulletin. It was written by Academy Coding Executive Sue Vicchrilli, COT, OCS.

 
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