OASIS ~ M0175 TAKEBACKS TO HIT IN JANUARY
Published on Tue Sep 26, 2006
CMS agrees to hold off long-delayed recoupments if provider appeals. If your OASIS information-gathering was lacking when PPS began, you'll soon have to pay the price.
The recoupment and refund process for incorrect answers to OASIS item M0175 will begin in January, a Centers for Medicare & Medicaid Services of-ficial tells Eli. The regional home health intermediaries will make M0175 adjustments for the first year of the prospective payment system only, stresses a spokesperson for RHHI United Government Services.
CMS originally planned for the recoupments to begin last November. But the agency held off on the takebacks when the industry protested they wouldn't comply with appeals rules contained in the Medicare Modernization Act.
How it will work: Between now and Jan. 18, 2007, the intermediaries will process all the M0175 adjustments but won't yet initiate takebacks or refunds, according to Oct. 20 Transmittal No. 1079. Then on Jan. 18, the RHHIs will issue demand letters for overpayments via first class mail.
Sixteen days after the intermediary sends a letter, it will initiate recoupment of the overpayment by withholding it against current claims payments, the memo spells out. However, the intermediary will delay withholding if it receives a "valid and timely request" for a contractor redetermination -- the first Medicare appeal level.
If the contractor upholds the overpayment, the intermediary can start recouping the amount between 30 and 45 days after the redetermination notice is issued. If the provider appeals to the next level, the Qualified Independent Contractor (QIC), the takeback is again put on hold.
If the QIC upholds the overpayment and the agency appeals to the third level, the Administrative Law Judge, the intermediary still will make the recoupment. The Medicare Modernization Act requires that Medicare hold off on recouping overpayments only through the second, QIC level of appeal.
While the memo doesn't spell out the particulars, it appears RHHIs will take back M0175 overpayments for fiscal year 2001 in one lump sum, observes William Dombi with the National Association for Home Care & Hospice's Center for Health Care Law. Cash Flow Threatened Intermediaries UGS and Palmetto GBA have not calculated how much the total recoupments and refunds will be for fiscal year 2001, representatives for each intermediary tell Eli. That figure should be available once they process the adjustments.
When intermediaries first issued the overpayment information last year, some agencies were looking at six-figure recoupments while others had only a few thousand dollars, Dombi notes. But for some small agencies, even a few thousand dollars will have a huge impact on cash flow, he warns.
Because CMS agreed to give back money for M0175 mistakes in agencies' favor as well as recoup for mistakes that resulted in overpayments, some agencies will even see refunds, points out consultant M. [...]
