Top 10 Duplicate Claim Submitters by Specialty

CMS continues to focus identification of provider compliance errors on duplicate claim denials through the CERT review process, which indicates the following specialties as high volume duplicate submitters:

Specialty % of claim denials for California

• 1. Otolaryngology 12.67%
• 2. General Practice 7.62%
• 3. Family Practice 7.18%
• 4. Physical Therapist in Private Practice 7.10%
• 5. Diagnostic Radiology 6.34%
• 6. Internal Medicine 6.29%
• 7. Cardiology 5.60%
• 8. Multiple Specialty Group 4.41%
• 9. Ophthalmology 4.38%
• 10. Clinical Laboratory 2.07%

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 by CMS and can result in additional auditing of providers. Carriers suggest that providers post payments and denials promptly and review denials in order to take the appropriate action.