Medicare Compliance & Reimbursement

CMS ‘Regrets Inconvenience’ of Erroneously Requesting Overpayments

Your physician treated a patient, you submitted a bill to Medicare, collected your payment, and that was that — until Centers for Medicare & Medicaid Services (CMS) sent you a letter demanding a refund since its records indicated you were treating a patient who was incarcerated on the date of service.

If you’re one of the practices that faced this puzzling dilemma, CMS is now backtracking, admitting that it misidentified “a large number” of services that it had classified as involving incarcerated beneficiaries. In some of these cases, CMS had requested a refund from you, and in others, MACs had initiated automatic recoupment for the funds. Then practices had to fight back and were asked to advise beneficiaries to contact their Social Security offices to clear up the issue.

Now that CMS admits that many of these patients were not, in fact, incarcerated at the time of service, the agency is “actively reviewing” data to correct inappropriate overpayment recoveries, and to change its process of identifying incarcerated patients. The agency notes that it “regrets any inconvenience and is working to resolve these issues as quickly as possible.”

CMS Clarifies Rules For Opting Out Of Medicare

If you’re one of the physicians who has decided to opt out of the Medicare program, you probably know that you’re expected to file an affidavit with Medicare, noting that you agree to opt out of the program for two years for all Medicare patients. However, if you’ve been searching the CMS website or online portals to find the official corresponding affidavit to complete, you’ve probably come up short.

That’s because CMS “does not have a standard affidavit form,” CMS notes in MLN Matters article SE1311, which the agency issued last week to clear up opt-out issues. “Medicare contractors must instruct those providers who wish to opt out to provide the information mentioned in writing to the Medicare contractor within their service jurisdiction.”

The affidavit must include the following, the MLN Matters article notes:

• Must be in writing and signed by the practitioner
• Must include statements in which the practitioner agrees not to submit claims to Medicare for any services furnished during the opt-out period, except for emergency or urgent care services furnished to beneficiaries with whom the practitioner has not previously entered into a private contract
• Must identify the practitioner so Medicare can ensure that no payment is made to that practitioner during the opt out period
• Must be filed with all Medicare contractors who have jurisdiction over the claims the practitioner would otherwise have filed with Medicare, and must be filed within 10 days after entering into the first private contract to which the affidavit applies.

For more about what you must include in your affidavit, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles  to read the complete article.

99310: Claims Review Reveals Missing Signatures

When Part B MAC CGS Medicare began its prepayment medical review of nursing facility care code 99310, the contractor was unsure of what it would find to explain why the code had been the source of so many errors in its system. But over the last few months, the agency compiled the data it collected about the code and found out that missing signatures were a big culprit.

CGS Medicare identified the following five areas as being the biggest issues among claims for 99310:

• Non-receipt of documentation. When CGS asked for documentation, many practices sent nothing at all, a letter without attached documentation, or no facility notes to support the code.
• Lack of signatures. If CGS found missing signatures, it asked the practice for an attestation, signature log, or signed note — but in many cases, these were all missing.
• Illegible documentation. Another reader must be able to read your provider’s documentation, but CGS found in many cases that notes were completely illegible.
• Provider performing services wasn’t the billing provider. In facility settings, “incident-to” is not permitted. Plus, in nursing facilities, split/shared visits aren’t permitted. However, CGS saw instances of both of these issues.
• Documentation did not support the level of care billed. In some cases, providers sent CGS cloned documentation, or notes with “continue current treatment” as the medical decision-making portion of the note. These were not acceptable for this high-level code.

To read CGS’s complete report, visit www.cgsmedicare.com.

Check Out This Hospice Billing Guidance

Looking for answers to your hospice billing questions, and a training resource for employees to boot? An updated educational resource from one MAC may help.

MAC NHIC has revised its Hospice Claims Submission Billing Guide. The 22-page guide offers field-by-field instructions for completing claims.

For example: “If revenue codes 0651 or 0652 are present, value code 61 has to be reported with the appropriate Core-Based Statistical Area (CBSA) code for the beneficiary’s location,” NHIC explains for the required “VALUE CODES” field.

The guide is online at www.medicarenhic.com/providers.