Physician’s Capitation Trends
Many practices paid twice for same service: OIG
Changes in pay practices recommended
The same Medicare claims are often paid twice because carriers’ processing procedures are not set up to catch duplicative payments, according to a study by the Office of Inspector General (OIG). What’s more, these double payments frequently go unnoticed by auditors. Based on its research, the OIG concludes that up to 25% of the providers studied had a "significant number of" (meaning at least 20) potential duplicate billing overpayments.
The OIG says confusion among carriers and providers about whom to submit bills to for specific services is the main cause of most double payments. Other reasons for duplicate billing include confusion resulting from carrier transitions, having offices or performing services across state lines, and inadvertent errors by billing services.
Some providers, for instance, told the OIG they submitted duplicate bills to Medicare because they just did not know which carrier to bill for a certain claim. One New York City physician told investigators that he learned that services he provided in Queens should be processed by a different carrier from the one that processed claims for services he provided in other locations.
He resubmitted his claim for the services delivered in Queens to the appropriate carrier, assuming he would not receive reimbursement from the incorrect carrier. However, he was reimbursed by both carriers for the same services rendered in Queens.
To prevent such multiple reimbursements, the OIG is recommending that the Health Care Financing Administration (HCFA) revise its Common Working Files edits to detect and deny duplicate billings to more than one carrier. These files were established in 1991 to improve the accuracy of Medicare claims processing. However, if HCFA determines this change is too costly, the OIG wants it to increase its post-payment reviews, especially in regions where providers commonly perform services in multiple carrier jurisdictions.
To access the report, "Medicare Payments for the Same Service by More Than One Carrier" (OEI-03-00-00090), check the OIG web site at www.hhs.gov/oig/oei/whatsnew.html.
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