Medicaid tightens payment rules

Thursday, February 11, 2010

TALLAHASSEE, Fla. - HME providers who fail to repay Medicaid for overpayments could get their Medicaid billing numbers yanked.

Historically, providers have been allowed to have overpayments deducted from their next regular Medicaid payment, but new rules change that. A Jan. 13 alert from the Agency for Health Care Administration (AHCA), which oversees Florida Medicaid, states that it will now withhold all Medicaid payments beginning 30 days following the notice of an alleged overpayment. If the provider fails to reimburse ACHA--or make arrangements to do so--within 35 days of receiving notice, their number will be terminated.

"It is a much harsher way to deal with what is a common problem," said Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services (FAHCS). "It really puts the burden on the provider."

Even worse, providers can't appeal the termination.

"According to ACHA, it's a fraud and abuse measure," said Joan Cross, executive director of the Florida Association of Medical Equipment Services (FAMES). "Basically, (AHCA) is going to say, "Well, why would this be a problem? They have 35 days to repay or make arrangements to repay.' They've got an out there."

Both FAHCS and FAMES were reaching out to alert providers to the changes in the rule.

FAHCS seeks clarification on the issue.