RE: Medicare Overpayment Recovery

[Guest guest]

Lydia

Whether a letter is being sent out or the r/Intermediary/MAC is

reprocessing claims, providers are being notified. While each provider could

write a letter of complaint to the CMS regional office, I think ultimately the

rs/Intermediaries/MAC's have that denial code that gives you 120 days from

the date of the reprocessing to appeal or you lose your right to a future

payment. I should interject at this point that whether you appeal or not, I

believe this will ultimately be ruled on favorably (in the Provider's favor).

As you indicated, as Medicare is reprocessing patient claims for 2010 adjusting

them upward for the change in the physician fee schedule, they are reprocessing

out of sequence, and thus an initial claim requiring NO KX goes over the cap and

either partially or fully denies. In addition, we have seen claims reprocess

and a second deductible get taken on the patient!

Our response has been to do the appeal. I would recommend the appeal route for

a couple of reasons, even though the administrative time involved can be

significant. First, there is potential that if you do not appeal, CMS will side

with the C/I/MAC and you would lose your right to get paid. Second, even if you

complain, government agencies, senators and congresspeople take forever to fix

things and there is a chance you will forget about this issue if they fumble the

ball. Third, every one of these that we have appealed has been ruled in our

favor in very short order. Finally, the C/I/MAC's don't like handling your

appeal any more than you like making them. They channel their comments back to

CMS, which in turn talk with our legislators about how their process messed

things up. So hopefully, if there is a next time (which is highly likely given

the way this issue seems to reappear), things will be handled more quickly with

fewer costs to the taxpayers.

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/892-0142

Visit our website at:

www.rehabmgmt.com

Medicare Overpayment Recovery

Is anyone else out there receiving request from Medicare to return them money

then resubmit the claims with the KX modifier. Seems that they started their

review starting with the last dates of service then worked backwards, meaning

that the earlier dates of service did not have the KX modifier on it. This is

going to cause A LOT of excess work on our part because of the way they have

done their reviews. What are others doing about this?

I have called our senators and congressman and the APTA.

Thanks for your help.

Lydia Radosevich,PT

Ruidoso,NM