Eureka! Thanks to the lovely ladies at Medicare and Medibank Private I have finally worked out the meaning of that elusive Error “432 – Not multi-op – more information required to pay benefit”.
If you are like me and many of my sites, occasionally you get a Medicare claim error either in the bulk billing or via ECLIPSE that you just can’t work out how to resolve. I have had some people say you need to send a report, and others just write it off. But it has all been guesswork…until today. Several people in Medicare claims had never even heard of the error and that never inspires confidence.
So what is the problem? When you see the 432 “not multi-op” error it means that for some reason the services for the procedure have been split and potentially paid separately. This might occur because a diagnostic item has been billed separately to its procedural items, or it might occur because one procedure item was claimed and then a second claim has been sent containing an item that should have been the first (100%) item on the account under the Multiple Item Rule. It might also arise because the health fund has, for some reason, split the items when they sent them to Medicare for approval. To put it another way, it means that Medicare have already paid an item that would have been paid at a lower rate (per the multiple item rule) had they received all the items together, so they can’t just pay on the extra item/s without adjusting the already paid item.
And the solution? The new item/s either need to be
Differentiated as having occurred separately. i.e. If the service/s were performed as two unique procedures, then they need to be differentiated by TIME in the item service text and by using the “not multiple procedure” Medicare override. In this case, the items will be paid as a separate procedure.
Reconciled as having occurred together. i.e. Medicare need to know that the items were performed together and Medicare will need to perform an adjustment of the already paid item. This is done using a single form – the Medicare HW023 form for Simplified Billing or ECLIPSE
adjustment or the Medicare DB018 form for a correction to a bulk billed claim. Complete the form with as much detail as possible, attach the correct invoice with ALL the items performed, and send it to Medicare for processing. They will either make a top up payment or request reimbursement. Make sure you specify clearly and exactly what you want them to do, otherwise they will send the form back for correction. And if in doubt, call Medicare for advice.
How can you avoid this error arising?
Ensure you have ALL the services to bill before you start, and put everything on the one invoice/claim. Simples! 🙂
I love learning new things. Have a great day – I am off to reconcile some more billing…