Eli's Hospice Insider

Published on Thu Feb 22, 2018 PDF

If you're a hospice provider that's been hit with an overpayment request from a Recovery Audit or other government contractor, and you've exceeded your per beneficiary cap, there may be a small silver lining.

"If a hospice is subjected to claim recoveries and has incurred a Medicare cap overpayment ... the hospice should request recalculation of cap liabilities subsequent to or simultaneously with the demand for claim recovery," urges consulting firm The Health Group in Morgantown, West Virginia. "Payment of claim-related demands may constitute overpaying, in some cases double paying the Medicare program because excess payments were previously determined as part of a cap analysis and repaid to the Medicare program. Denied claims, or claim-related overpayment determinations should be used to reduce payments that were previously used to determine cap liabilities."

But while "beneficiary counts may also be reduced as a result of the claim-related denials ... generally the reduction in any beneficiary count is insignificant to the reduction in Medicare payments," the firm says in its electronic newsletter.

Bottom line: "Make certain that any claim denials or claim repayments are factored into the determination of cap liabilities," The Health Group recommends.