Wiki Billing and recoupment questions

[Katrinahoward76]

I am trying to gather information about some billing processes, namely Medicare. But, private payors are included as well as patients themselves. I am concerned with possible fraud and intent to nip anything in bud.


I am good with general info on reimbursements but I have some specific questions.


1. When Medicare or Medicaid notifies you of an over payment and you tell them to recoup, how long do they have to complete this process? Whose burden does it lie on if they do not recoup after being told to and we know about it? We know we have an over payment. We faxed back to Medicare, the private payor, or medicaid to recoup and they still have not done it. We do not receive any confirmation from Medicare ect.. that they received the response other than a fax confirmation.



2. If there are credit balances due to both patients and insurance companies from a business no longer producing claims should those be refunded directly? We went from an INC to an LLC with a new Tax ID. The INC no longer has any claims going out so there are no EOB's or payments to recoup from. We have refunds and over payments to give back. Wanting to know the proper process for completing this.


3. How do I show that writing off invoices / claims as bed debt when they are not is wrong? I have found where there are cases that rejections did not get worked or a claim never filed and then get wrote off as bad debt to remove them from the AR.


Thanks for your help. Any documentation that I can be directed to would be great. I have read and read, but I can't find anything to directly answer my questions. I want to make sure my organization is doing things correctly.

 

[RhondaCPC]

I hope I can help a bit. Please see my reply under each question.

1. When Medicare or Medicaid notifies you of an over payment and you tell them to recoup, how long do they have to complete this process? Whose burden does it lie on if they do not recoup after being told to and we know about it? We know we have an over payment. We faxed back to Medicare, the private payor, or medicaid to recoup and they still have not done it. We do not receive any confirmation from Medicare ect.. that they received the response other than a fax confirmation.

For Medicare, you typically have 60 days to refund. They will begin the recoupment process on day 41. Here is a helpful CMS link: http://www.cms.gov/Outreach-and-Edu...ducts/downloads/overpaymentbrochure508-09.pdf

2. If there are credit balances due to both patients and insurance companies from a business no longer producing claims should those be refunded directly? We went from an INC to an LLC with a new Tax ID. The INC no longer has any claims going out so there are no EOB's or payments to recoup from. We have refunds and over payments to give back. Wanting to know the proper process for completing this

You will need to refund these patient directly from the INC business account.

3. How do I show that writing off invoices / claims as bed debt when they are not is wrong? I have found where there are cases that rejections did not get worked or a claim never filed and then get wrote off as bad debt to remove them from the AR.

If your company never filed a claim, it would be written off as timely filing limitation, not bad debt. To write off a copay, co-insurance or deductible without sending 4 patient statements and proving financial hardship, I would not recommend this as a practice. But, because there are several scenarios for collections and bad debt, I would have to have more specifics. You can, however, find additional information on cms.gov


I hope this helps!