Home Health & Hospice Week

Steamed about the reimbursement withheld for supposedly incarcerated beneficiaries? You now have a powerful ally. CMS recouped funds for these beneficiaries earlier this summer (see Eli’s HCW, Vol. XXII, No. 26).

"Beneficiary data used by CMS to identify periods of incarcerations was, in some cases, incomplete and that recovery actions may have been inaccurate," the American Medical Association says in a letter to Centers for Medicare & Medicaid Ser-vices Administrator Marilyn Tavenner. "This has resulted in CMS seeking to recoup Medicare payments that were in fact correctly paid."

Some Medicaid programs also are initiating recoveries based on the incorrect recoupments, the AMA protests. "Recognizing these errors and the burdens placed on providers, we urge CMS to halt its recovery efforts," the AMA asks.

"To confirm a patient’s status, CMS recommends that providers call their Medicare Admini-strative Contractor (MAC) to inquire whether a patient is incarcerated," the trade group notes. "This additional administrative duty, however … is overly burdensome given that these inquiries may only affect a small portion of patients."

Providers generally also had no idea that Medicare had such a broad definition of "incarcerated," including individuals on home detention, medical furlough, parole, etc. "CMS should not unjustly … retroactively seek overpayments" for these claims, the AMA urges. "Rather, CMS should finalize clear, bright-line guidance to educate providers going forward regarding these types of claims."

CMS has said it will straighten out incorrect recoupment appeals by October (see Eli’s HCW, Vol. XXII, No. 28).