Wiki Tricare REFUND Requests

[orthotrauma]

We got a massive refund request (ASC) for 'overpayment' of several 2007 claims from Tricare Humana Military - South Region (Texas).

According to rule 133.260, they only have 240 days to request a refund, or 30 days from audit (according to 133.230) on a processing claim.

These claims have all been finalized two years ago.

My question is: since this is a 'government' plan, are they handled differently?

Thanks y'all!
~Dawn, CPC

 

[Radcoder1313]

If I'm not mistaken, any of the government plans can request from as far back as they would like to.

 

[LLovett]

The bigger question, in my mind, is what triggered this request.

The OIG work on some cases for years, so reading enforcement actions for the past few months you will see claims from 2002-2004 and other old date ranges just now being addressed.

I know Tricare is slow to pay and process so it wouldn't shock me that they are slow to take back as well.

Regardless of why it took so long or what caused it at all, I would take a good long look at the things they are looking at and make sure they are being done correctly now.

Laura, CPC