CMS Incorrectly Recovered Payments To Providers
By Greg Bengel, contributing writer
CMS must now work to correct payments recouped and claims denied in error, as its information was “incomplete for purposes of collection”
Last Tuesday, in an open door telephone forum with physicians, CMS owned up to incorrectly recovering payments and denying legitimate claims to providers in situations in which the patient was believed to be incarcerated.
Generally, explains an article from Medpage Today, Medicare will not pay for services provided to patients who are either in custody or incarcerated at the time of the services. In accordance with this policy, CMS has recovered payments and denied claims for patients who were thought to have been incarcerated.
But as it turns out, says Medpage Today, “CMS has since learned much of the information was ‘incomplete for purposes of collection’ and may have resulted in recovering payments that were correctly paid.”
Louisa Rink of CMS said “CMS understands that the issue has been challenging for providers, and we are actively addressing it.” CMS is trying to fix the problem by working with claims data to identify the mistakes and change the system. Rink says that the process of identifying what claims were denied in error, and then reprocessing those claims, will be delegated to the Medicare Administrative Contractors. Medpage Today says there is no target date for fixing the problem, but that Rink already said it would not be completed by October.
The American Medical Association was none too happy about the concession. In a recent letter to CMS Administrator Marilyn Tavenner, the AMA addresses the CMS mistakes. The letter concedes that CMS has addressed the errors and has made a plan to fix them, but argues that that is not enough, and that recovery efforts should be stopped altogether.
The letter reads, “Recognizing these errors and the burdens placed on providers, we urge CMS to halt its recovery efforts. Instead, CMS should take action to improve the process used to identify periods of incarceration and clarify denial forms and notices so that providers are aware of the explicit reason justifying a recoupment.”
The letter says that the requirements placed on physicians to confirm incarceration status of patients interferes with a physician’s focus on patient care, and that it is “overly burdensome.” “While under certain circumstances providers may be aware that a patient is incarcerated, in other instances providers may have no indication of a patient’s status, especially if the patient is residing in a halfway house, living under home detention, on parole, or unconscious and unable to convey that he or she is in custody,” the letter points out.