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Printed Date: 9/22/2015
Outpatient claim overlaps another outpatient claim for same provider and same date of service.
Explanation and Suggestion:
Verify OPPS bill types 12X, 13X, 14X, 76X, 75X, or any claim reporting condition code (CC) 07 doesn’t overlap service dates from same provider unless CC G0, 20 or 21 is present.
Billing that appears to be deliberate application for duplicate payment of services may be considered fraud under provisions of Medicare program. Errors brought to a facility’s attention must be corrected & failure to do so will provide reasons to open an investigation.
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Last Updated: 12/27/2018