Wiki Refunds

[coder1]

Our practice are currenlty sending voluntary refunds to MCR as primary. Would MCR notify the secondary that paid on these claims?

Thanks

 

[btadlock1]

Our practice are currenlty sending voluntary refunds to MCR as primary. Would MCR notify the secondary that paid on these claims?

Thanks

I'm confused, but it sounds like you're saying that Medicare paid as primary, when they should have been secondary, and you're sending refunds to MCR when you find out. If that's the case...
File to the correct primary insurance. Medicare won't do it for you. If it's past timely filing, you NEED a refund request/recoupment EOB from Medicare to submit to the commercial plan, to start the timely filing deadline over.
If you're still within the commercial filing deadline, your best bet is to wait until you've received payment from the commercial payer, and refund the difference to Medicare. The commercial payer doesn't need to know whether or not you were overpaid by Medicare, or if you've fixed the problem - that's none of their business, unless you need to extend a filing deadline. Hope that helps!

 

[coder1]

We recieved primary (MCR), and secondary (commericial) payment for claims that needs to be voluntary refunded. Would MCR notify the secondary once we send MCR (primary) there refund?

 

[btadlock1]

We recieved primary (MCR), and secondary (commericial) payment for claims that needs to be voluntary refunded. Would MCR notify the secondary once we send MCR (primary) there refund?

I'm interested in why you're concerned about this - if there's a reason you're voluntarily refunding Medicare, then that tells me that you've received payments, which you now have reason to believe were made improperly. You have a legal obligation to submit those refunds in a timely manner to CMS upon discovery of the improper payment, and your obligation also extends to any secondary payments you may have received; the bottom line is, if you shouldn't have been paid, the money's not yours, and you must return it as soon as possible.

That said, Medicare will notify a secondary payor when a claim has been reprocessed, if they are set up to crossover the information, without prompting. I can't tell you for certain whether or not they would disclose a voluntary refund, particularly without knowing the context of the refund. I wouldn't recommend withholding any improper payments from anyone, on the slim chance that they'll never find out about it.

 

[coder1]

Thanks for your response. We are sending VOLUNTARY refunds. I'm not sure where it came across that we weren't. The question was if the primary notify secondary of refund.

 

[btadlock1]

Thanks for your response. We are sending VOLUNTARY refunds. I'm not sure where it came across that we weren't. The question was if the primary notify secondary of refund.

No - I got that they were voluntary. But you know, the only difference between a voluntary refund, and an involuntary one, is who catches the mistake first.

My question is - why is it important whether Medicare notifies secondary of the refund or not? So that you don't need to explain why you're also sending them a refund, or so that you don't have to send them one at all? If you're voluntarily refunding one, you should voluntarily refund the other at the same time.

If you're just sending refunds because you're feeling generous, and not because a mistake was made (which is the only circumstance that you'd be able to only refund one, and not the other - Who knows? Maybe you're just doing your part to reduce the deficit ), then I could see why it might matter if the two are sharing info, but otherwise, it's a moot point. (If that is the case, then I've got an address you can voluntarily send some cash to, while you're at it.) Whether Medicare tells the secondary or not, you should send out the refunds to both at the same time.

 

[clark100]

I understand completely. We've realized the need to voluntarily send these refunds to Medicare as well and wondered if we should go ahead and voluntarily refund the secondary payer. I'm not sure if Medicare forwards this information to the secondary or not, so we've always opted to refund both insurances at the same time. That way, it's done and we don't have to worry about it any longer. Hope this helps.

 

[FTessaBartels]

Reason for refund

If you are refunding - voluntarily, I get that - because an internal audit has shown that the documentation does not support the charge, then you should be voluntarily refunding to anyone who paid you for the undocumented service.

Hope that helps.

F Tessa Bartels, CPC, CEMC