0064 - Facility Duplicate Claims

Dynamic List Information
Dynamic List Data
Issue Name
0064 - Facility Duplicate Claims
Review Type
Automated
Provider Type
Inpatient Hospital; Outpatient Hospital; Skilled Nursing Facility (SNF)
MAC Jurisdiction
All A/B MACs
Date
2017-09-06
RAC Type
Approved

Description

Duplicate claims or line date of service items will be denied.

Affected Code(s)

All CPT and All HCPCS

Applicable Policy References

1.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3.    42 CFR §405.929- Post-Payment Review
4.    42 CFR §405.930- Failure to Respond to Additional Documentation Request
5.    42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6.    42 CFR §405.986- Good Cause for Reopening  
7.    Medicare Claims Processing Manual, Chapter 1 – General Billing Requirements, §120.2- Exact Duplicates
8.    Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
9.    AMA CPT Codebook
10.    HCPCS Level II Codebook