Tag: Overpayments
Researchers call for Medicare Advantage reform
June 19, 2023HME News Staff
LOS ANGELES – A new analysis by researchers at the University of Southern California warns that overpayments to Medicare Advantage plans now exceed 20%, or $75 billion annually, underscoring the urgent need for reform.
Researchers with the USC Schaeffer Center for Health Policy & Economics found that the millions of beneficiaries in traditional Medicare who have switched to Medicare Advantage plans have lower spending than those with similar health risks. They report this pattern of...
In brief: Stakeholders launch bid website, Simply Home sues HHS
April 19, 2019HME News Staff
WASHINGTON - A group of HME industry stakeholders has officially launched dmecbpeducation.com, a website for providers to learn about the changes in Round 2021 of competitive bidding and to prepare their bids.“Informed bidding will help sustain DME businesses, ensuring that patients' access to life-changing medical equipment remains steady, stable and secure,” said Tom Ryan, president and CEO of AAHomecare.Stakeholders had already loaded the website with bid calculators that allow providers...
Simply Home sues HHS over overpayments
April 18, 2019HME News Staff
CHICAGO - Simply Home Health Care, a home health agency based here, has filed a lawsuit in the U.S. District Court for the Northern District of Illinois against the Department of Health And Human Services and AdvanceMed, a UPIC, for continued suspension of payments from the Medicare program, according to healthcare attorney Elizabeth Hogue. Payments to Simply Home were originally suspended because of overpayments, but the agency was later told by AdvanceMed that payments were suspended because of...
Overpayments: Create culture of compliance
August 22, 2016Josh Skora
A. In previous columns, I discussed how the 60-day overpayment rule presents a myriad of problems and questions that are sometimes difficult for an HME supplier to identify and address. However, the most effective remedy to overpayment problems is the implementation of and adherence to a robust compliance program. Overpayments will still arise, but the compliance program sets the stage for a corporate culture of compliance.
The Affordable Care Act mandates that suppliers have compliance programs,...
CGS changes offset request process
July 26, 2016HME News Staff
NASHVILLE, Tenn. - CGS Administrators, the Jurisdiction B MAC, will no longer accept offset requests at the time of claim re-openings and adjustments, it said in a July 25 bulletin. Starting Aug. 1,suppliers who wish to have an overpayment withheld from future payments must wait for a demand letter. Upon receipt of the demand letter, the supplier may submit a request for immediate offset with, at minimum, a copy of the first page of the demand letter. Suppliers will have the option to submit a request...
Overpayments: Follow protocol
July 25, 2016Josh Skora
A. Typically, suppliers report and return overpayments to the DME MAC of jurisdiction. Each DME MAC has a standard overpayment refund form. The supplier simply provides information and submits a refund check. Suppliers must indicate a reason for the overpayment. A few of the available reasons are: billed in error, insufficient documentation, services not rendered and medical necessity. The refund is a dollar-for-dollar payment. No penalty is assessed.
On the other hand, in cases that involve...
Overpayments: Extrapolate overpayments
June 21, 2016Josh Skora
A. My last column explained CMS's final rule clarifying the 60-day rule, which allows a supplier up to six months to quantify an overpayment once it's identified. Once the supplier quantifies the overpayment, it has 60 days to report and refund the overpayment. However, there is little, if any, guidance on how in-depth an investigation must be to quantify the scope of an overpayment.
Take the following hypothetical: A supplier has a sales representative in each of the five states it conducts...
Overpayments: Exercise reasonable diligence
May 23, 2016Josh Skora
A. The Affordable Care Act requires a person who has received an overpayment to report and return the overpayment to the government.
For HME providers, overpayments must be reported and returned within 60 days after the date on which the overpayment was identified. This led to many unanswered questions. What does “identified” mean? If a provider uncovers one overpaid claim, is it required to investigate all related claims? When does the 60-day clock start? How far back must the provider...
GAO pokes holes in CMS's MA audit program
May 10, 2016HME News Staff
WASHINGTON - The Government Accountability Office isn't pleased with CMS's progress in recovering substantial amounts of improper payments from Medicare Advantage organizations. The agency currently uses risk adjustment data validation audits to recover improper payments in the MA program. The GAO found that CMS's methodology does not result in the selection of contracts for audit that have the greatest potential for recovery of improper payments. The GAO also found “substantial...
Providers must report overpayments going back six years
February 12, 2016HME News Staff
WASHINGTON - CMS has revised the look-back period for overpayments from 10 to six years, according to a final rule issued Feb. 11.Medicare Parts A and B healthcare providerswho discover Medicare overpayments within six years of the initial date reimbursementwas receivedmust report and repay them within 60 days to avoid liability under the False Claims Act, the rule states.“Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary...