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Wiki Medicare Recoups for Incarcerated Patients

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fishbite2

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Has anyone else had refund requests or recoups for patients listed by SSN as incarcerated who were not actually incarcerated on the date of service? We have received them for three patients. All three had previously been incarcerated but were released several months before we saw them. My understanding is that if the patient is on probation or parole it does not effect their Medicare coverage.
 
fishbite2 said:
Has anyone else had refund requests or recoups for patients listed by SSN as incarcerated who were not actually incarcerated on the date of service? We have received them for three patients. All three had previously been incarcerated but were released several months before we saw them. My understanding is that if the patient is on probation or parole it does not effect their Medicare coverage.
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Palmetto GBA:

There may be instances where providers believe that the beneficiary was not incarcerated when the service was provided. However, a beneficiary may be “incarcerated” even when the individual is not confined within a penal facility. For example, a beneficiary who is on a supervised release, on medical furlough, residing in a halfway house, or other similar situation may, nevertheless, be in the custody of authorities under a penal statute. In such cases, Medicare payment may be barred. Providers receiving demand letters for denial of claims because the beneficiary's SSA record indicates incarceration on the DOS, and who have reason to believe that the beneficiary was not incarcerated on the DOS, may wish to contact the beneficiary to gather as much information as possible.

http://www.palmettogba.com/palmetto...to Incarcerated Beneficiaries?open&cat=events
 
Medicare Recoupments for incarcerated patients

Hello!

So far we received recoupment for 3 patients as Medicare found that patient was incarcerated at time of service. My physicians see patients in hospitals, and we are unable to contact patients to confirm incarceration status. Any one can advise, how can handle these cases and get repaid.

Thanks for any help.
 
We have been having them at our office too. When I called Medicare, they are saying that there was a glitch in their computer system and that we should hold off sending any payment back to them unless you receive another letter from them. They are talking to the Department of Corrections to establish if these patients were incarcerated at the dos or not. My suggestion is to call Medicare and see if you fall into that same catagory as we did.
 
We've received two requests. Both were patients seen in the hospital, neither was referred by a jail or prison, and one was actually said to be living with relatives and recently released from probation. However, when I called WPS, I was told "incarceration doesn't necessarily mean confined to a prison - it might mean a supervised release" and "you should bill the patient."

WPS e-mailed an explanation pretty much the same as the post above mine.

I have yet to hear that it's o.k. to NOT refund the money until the matter is straightened out.
 
Great Info! Thanks everyone. Several of these just came across my desk earlier this week.
Unfortunately for our billing staff they have no way of knowing the out of jail/prison but still under supervision status of the patient. I guess one way to identify the status would be to query the patient the first time they arrive without a police escort.
 
I've gotten demand letters for over 3yrs worth of home visits & now patient is currently being denied. I've talked to the patient he was barred from Medicare (apparently he was sent a form after we started receiving these requests) asking him about if he was in jail. I read that we were suppose to just wait it out till Medicare got this all fixed. But now I see this is posted http://www.cms.gov/Medicare/Medicar...oads/Incarcerated-Beneficiary-FAQs-8-1-13.pdf Being that it's more then 3yrs worth of claims, I don't want Medicare to automatically take the payment & we have to wait for them to fix their systems. My questions is does anyone have an idea what kind of proof to send with an appeal. It's not like I can obtain discharge papers (jail is out of state & he was released over 7yrs ago). I really want to prevent refunding but not sure how to go about it. If anyone has done this & could advise that would be great.
 
Medicare Recoupments

We are in a same boat. My physicians see patients in hospitals and for some patients even we do not have correct address or phone number to contact them. So It is hard to verify with patients. I guess, if Medicare sent recoupment letter, then first we should request offset and then work with Medicare to repay if denial is an error. This way we will not have to pay interest to Medicare.
 
Medicare Update

I called Medicare and rep advised they have updated the patient's data and none of my patients were incarcerated. She advised to send redetermination and Medicare will pay back.
 
CMS Update

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.”
 
Medical Provider who do not accept assignment with Medicare> Why did we get a check?

I noted that the provider received a Medicare EFT into his practice account. This provider does not accept assignment. What are the penalty for a provider keeping Pt payments. Let me take that back. He refunds the PT their money back either by offering a credit to be applied towards their next office visit or he write out a check. This has happen with PT that have been receiving their reimbursement directly from Medicare. Anyone out there have some insight that they would like to share.
 
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