Medicare incarceration recoupment and appeal option

RECOUPMENTS 

Q1: Do suppliers and providers need to take any steps to be repaid for incorrect recoupments resulting from this issue? 

A1: Supplier claims will be reprocessed and refunds issued by the end of the first week of December 2013. The majority of non-supplier provider claim refunds will be made by the middle of December. Last updated 11-27-13

Q2: Will Medicare repay the recoupments with interest? 

A: The Medicare statute only permits CMS to pay interest under limited circumstances, and this situation does not trigger the payment of interest to providers and suppliers. Last updated 11-27-13

Q3: What happens to corrections of recoupments that occur after a new MAC has taken over a jurisdiction? 

A3: All claims and accounts receivables have been transferred to the incoming MAC.
Last updated 11-20-13

Q4: If a provider or supplier paid interest on one of the collected overpayments, will the repayment of that claim include the amount of interest the provider or supplier paid? 

A4: Yes, the provider or supplier will receive a refund for the amount paid including any interest paid.


I continue to receive demand letters and the MAC continues to recoup money for an incarcerated beneficiary related overpayment. What should I do?

A5: While CMS previously zeroed out most of the incarcerated beneficiary overpayments, due to changes in our records over the years, we are still working to identify, zero out, and process refunds for some of the erroneous overpayments. If you are aware of an incarcerated beneficiary overpayment that is still being collected, you should bring it to the attention of your MAC as soon as possible.

APPEALS

Q1: Can I appeal the denied claim? Who is liable for the denied claim? 

A1: Yes, providers, suppliers, and beneficiaries can appeal the denied claims. Liability for the denied claims will be determined for each claim on a case by case basis.
Last updated 11-20-13

RECOUPMENTS

Q1: Do suppliers and providers need to take any steps to be repaid for incorrect recoupments resulting from this issue?

A1: Supplier claims will be reprocessed and refunds issued by the end of the first week of December 2013. The majority of non-supplier provider claim refunds will be made by the middle of December. Last updated 11-27-13

Q2: Will Medicare repay the recoupments with interest?

A: The Medicare statute only permits CMS to pay interest under limited circumstances, and this situation does not trigger the payment of interest to providers and suppliers. Last updated 11-27-13

Q3: What happens to corrections of recoupments that occur after a new MAC has taken over a jurisdiction?

A3: All claims and accounts receivables have been transferred to the incoming MAC.
Last updated 11-20-13

Q4: If a provider or supplier paid interest on one of the collected overpayments, will the repayment of that claim include the amount of interest the provider or supplier paid?

A4: Yes, the provider or supplier will receive a refund for the amount paid including any interest paid.


I continue to receive demand letters and the MAC continues to recoup money for an incarcerated beneficiary related overpayment. What should I do?

A5: While CMS previously zeroed out most of the incarcerated beneficiary overpayments, due to changes in our records over the years, we are still working to identify, zero out, and process refunds for some of the erroneous overpayments. If you are aware of an incarcerated beneficiary overpayment that is still being collected, you should bring it to the attention of your MAC as soon as possible.

APPEALS

Q1: Can I appeal the denied claim? Who is liable for the denied claim?

A1: Yes, providers, suppliers, and beneficiaries can appeal the denied claims. Liability for the denied claims will be determined for each claim on a case by case basis.
Last updated 11-20-13

Q2: Once CMS reprocesses the inappropriate claim denials/cancellations, will there be a way for providers to appeal denied claims that were deemed appropriate even if the time limits for filing appeals expired?

A2: The Medicare Administrative Contractors have been instructed to accept appeal requests for claim denials or overpayments related to incarcerated beneficiaries without regard to the time limits for filing appeals.
A2: The Medicare Administrative Contractors have been instructed to accept appeal requests for claim denials or overpayments related to incarcerated beneficiaries without regard to the time limits for filing appeals.