Medicare Compliance & Reimbursement

The check may be in the mail - but you might never see it anyway. A mix-up with the address you have on file with your durable medical equipment regional carrier could mean you never receive any more Medicare checks at all. A single returned check might lead to a moratorium on payments. If you change your address and don't notify the DMERC, the Postal Service isn't allowed to notify the DMERC of your new address, notes the HHS Office of Inspector General in a new report on the "Do Not Forward Initiative" (A-02-02-01023). Until you provide a valid address to the DMERC, any claims received after one mailing bounces won't result in checks to the provider. Those claims will be "processed for adjudication only."

The fiscal intermediaries using the Fiscal Intermediary Shared System will begin using the "Do Not Forward" initiative "in the near future" as well, the report notes. That means many home health agencies will have to be more careful about providing a valid address to their intermediaries, or they'll miss out on payments as well. Also, the DNF initiative expanded last October, when the Centers for Medicare & Medicaid Services amended the Medicare Carriers Manual to say hardcopy remittance notices also should bear the "Do Not Forward" stamp. Not only that, but DMERCs now won't pay suppliers by electronic funds transfer if they suspect the supplier's address may have changed, says a recent carrier bulletin. Suppliers can update their addresses on file by using the 855B or 855S forms, for group providers and non-group providers respectively. The OIG says CMS has instructed carriers to void checks that come back in the mail and hold on to them for a year as "other liabilities."

But due to weaknesses in the claims systems used by DMERCs and carriers, some returned items aren't being posted properly as expenses and liabilities. Instead they're being recorded as voided checks, warns the OIG in its report. That's leading the DMERC and carriers in Region II to misstate more than $4.8 million in their financial reports, notes the OIG. The review also identified weaknesses in the shared systems that handle the reporting of DNF activity, which the OIG referred to CMS for consideration.