Part B Insider (Multispecialty) Coding Alert

Published on Thu Jun 13, 2013 PDF

Plus: OIG wants pro-rated hospital pay for hospice discharges.

CMS has found a clever way to ensure that you repay money that the program overpaid to you. If you have an existing Medicare overpayment that you haven’t repaid in full and you complete a new enrollment application, the agency may deny that enrollment.

That’s the word from MLN Matters article MM8039, issued on May 31 and effective on Oct. 1. The new directive doesn’t just depend on whether the applying physician or non-physician practitioner owes the money. In fact, that practitioner will be denied even if apartner at the practice owes money.

“An enrollment application may be denied if the current owner of the applying provider or supplier or if the applying physician or non-physician practitioner has an existing or delinquent overpayment that has not been repaid in full at the time the application was filed,” the article states. “The term ‘owner’ means any individual or entity that has any partnership interest in, or that has five percent or more direct or indirect ownership of the provider or supplier,” it says.

To read the article in its entirety, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8039.pdf