Preventing duplicate claim denials

Effective July 1, 2013, new claim system edits may result in additional duplicate claim denials. CMS has instructed Medicare contractors to enhance claim system edits to include same claim details in its history review of duplicate procedures and/or services. The edits will search within paid, finalized, pending and same claim details in history. This means that unless applicable modifiers are included in your claim, the edits will detect duplicate and repeat services within the same claim and/or based on a claim previously submitted. Some services on a claim may appear to be duplicates when, in fact, they are not. Please ensure appropriate use of modifiers to identify procedures and services that are not duplicates.