Medicare advantage overpayment recovery

What is the correct claim for overpayment recovery? How long does Medicare contractor have to recoup? How is an overpayment determined? Welcome to the world of Medicare Advantage , or “MA. The answer to your questions is that MA plans have denied and adjusted claims, taking payments back electronically.

MA entities are private, for-profit companies that deal with as much as half of your traditional Medicare population. Failure to return an overpayment within days of identification can lead to “ reverse” False Claims Act liability, i. A Medicare Secondary Payer (MSP) overpayment can occur when Medicare has processed and paid a claim as the primary payer, but should have paid as secondary. Reporting an MSP overpayment to Medicare without submitting a payment The MSP Inquiry Form must be submitted along with the primary insurer EOBs.

UnitedHealthcare’s claim processing steps UnitedHealthcare receives, processes, and sends payment for a claim. A Medicare overpayment is a payment made to a physician or supplier that exceeds amounts due and payable under Medicare statute and regulations. Once the overpayment is determine the amount becomes a debt owed by the debtor to the Federal government. Federal law requires CMS to seek the recovery of all identified overpayments. The Affordable Care Act calls for the program to be expanded to cover Medicare Advantage plans, and last month CMS released a draft Scope of Work to “solicit comment on, and interest in CMS entering into a contract with RACs to identify underpayments and overpayments.

Once a determination of an overpayment has been made, the amount is a debt owed by the debtor to the United States Government. Medicare contractors can begin recoupment no earlier than days from the date of the initial overpayment demand but shall cease recoupment of the overpayment in question, upon receipt of a timely and valid request for a redetermination of an overpayment. Request for refund letters will be sent by mail for all providers. Please review your refund letter closely and remit your refund to the. If you wish to challenge any overpayment recovery actions by our plan, you may dispute the amount of the refund request in writing to the P. Box listed above, within days of the date of the initial notice.

Step 2—Reporting of the actual recoupment (money is offset). IMPACT OF OVERPAYMENT Following the introduction of severity-based MS-DRGs, hospitals appeared to be over-coding to obtain higher payments. An “overpayment” is any funds received under Title XVIII (Medicare) or XIX (Medicaid), to which, after applicable reconciliation, the provider is not entitled (under these titles). Overpayments and Refunds Chapter 12.

The deadline for these two actions is the later of the date that any corresponding cost report is due or days after the overpayment is identified. If a plan is selected for an RADV audit under the new methodology, it will be critical for the plan to respond quickly and thoroughly in order to minimize an extrapolated overpayment recovery. When Medicare identifies an overpayment , the amount becomes a debt Provider owe the Federal government. The Non-Group Health Plan (NGHP) industry is not only experiencing increased recovery demands from Medicare Advantage Plans (MAPs) as of recently, but are also experiencing MAPs attempting to assert a greater right of recovery for conditional payments than traditional Medicare would have available.

Use this form to initiate an immediate offset of an overpayment if you have received an overpayment from Blue Cross Blue Shield of Michigan for a Medicare Advantage claim. Using this form automatically generates the offset and you will not receive additional notifi cation before the offset begins. Comment: Commenters raised concerns about the potential for a provider or supplier to refund overpayments and that those refunded claims may become the subject of an audit by a Medicare contractor, such as a Medicare Recovery Contractor, or the OIG in the future. A commenter requested that CMS clarify that Medicare contractors should take appropriate steps to remove any claims that are the. The most efficient way to dispute an overpayment is to use the overpayments application on the Availity Portal.

To get started: Access the overpayments application on the Availity Portal at Availity. In the application, click the action menu on the card for the overpayment you wish to dispute.