Home Health & Hospice Week

If you’ve encountered strange Medicare payment recoveries because your patients were supposedly incarcerated, hold on — there may be a mistake. "Medicare identified previously paid claims that contain a date of service partially or fully overlapping a period when a beneficiary was apparently incarcerated based on information CMS receives from the Social Security Administration," the Centers for Medicare & Medicaid Services explains in a message to providers. "As a result, a large number of overpayments were identified, demand letters released, and, in many cases, automatic recoupment of overpayments made."

Possible error: "CMS has since learned that the information related to these periods of incarcerations was, in some cases, incomplete for CMS purposes," the agency says. CMS is reviewing the data for accuracy and will correct inappropriate recoveries "quickly," it pledges.

But don’t be so sure you’ll get your payment back. "Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated when the items and services were furnished," CMS explains. "A beneficiary may be ‘incarcerated’ even when the individual is not confined within a penal facility, such as a beneficiary who is on a supervised release, on medical furlough, residing in a halfway house, or other similar situation."

For now, "providers and suppliers should no longer encourage beneficiaries to contact their local Social Security office in order to have their records updated as a result of this recent issue," CMS directs. "Providers also should no longer fax information to their local CMS Regional Offices as CMS is currently working to develop processes to resolve this issue."