A Medicare Advantage plan is recouping their payment for a nursing home visit, stating they have not received needed information from another provider. That provider is the nursing home. Do we have any recourse? Can we appeal the recoupment? We have no control over other providers furnishing information.
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Wiki Medicare advantage recouping $$
- Thread starter PennyG
- Start date
MC Advantage Recouping
Yes, Penny they can recoup. If you can contact them again and see if you can get the name of the other provider and I would contact them if you can. Tell them your payment is being recouped due to them not submitting the requested information. It is a hard place to be in since you can't bill the patient without a signed ABN on file. Most of the providers will send in the information when you request it. If all else fails, contact the patient and ask them what providers they saw for that date if the insurance company won't give you that information and explain to the member you need help in getting their bill paid they usually will help you if need be. I used to work for one of the big 5 in the Medicare Advantage division and have seem my fair share of takebacks for small things that you would think is trivial for them to do, but if the law allows it they do it!
-Phyllis D- CPC,CPC-P, CPC-I
Yes, Penny they can recoup. If you can contact them again and see if you can get the name of the other provider and I would contact them if you can. Tell them your payment is being recouped due to them not submitting the requested information. It is a hard place to be in since you can't bill the patient without a signed ABN on file. Most of the providers will send in the information when you request it. If all else fails, contact the patient and ask them what providers they saw for that date if the insurance company won't give you that information and explain to the member you need help in getting their bill paid they usually will help you if need be. I used to work for one of the big 5 in the Medicare Advantage division and have seem my fair share of takebacks for small things that you would think is trivial for them to do, but if the law allows it they do it!
-Phyllis D- CPC,CPC-P, CPC-I