38038

FISS Narrative
Outpatient claim overlaps another outpatient claim for same provider and same date of service.

• Whether any revenue code lines are equal or not

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.

• Adjust previously processed claim to add charges

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.