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Tag: Overpayments


News

In brief: Stakeholders launch bid website, Simply Home sues HHS

April 19, 2019HME News Staff

WASHINGTON - A group of HME industry stakeholders has officially launched dmecbpeducation.com, a website for providers to learn about the changes in Round 2021 of competitive bidding and to prepare their bids.“Informed bidding will help sustain DME businesses, ensuring that patients' access to life-changing medical equipment remains steady, stable and secure,” said Tom Ryan, president and CEO of AAHomecare.Stakeholders had already loaded the website with bid calculators that allow providers...

Calculator, Competitive Bidding, Lawsuit, Overpayments


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Simply Home sues HHS over overpayments

April 18, 2019HME News Staff

CHICAGO - Simply Home Health Care, a home health agency based here, has filed a lawsuit in the U.S. District Court for the Northern District of Illinois against the Department of Health And Human Services and AdvanceMed, a UPIC, for continued suspension of payments from the Medicare program, according to healthcare attorney Elizabeth Hogue. Payments to Simply Home were originally suspended because of overpayments, but the agency was later told by AdvanceMed that payments were suspended because of...

Elizabeth Hogue, Lawsuits, Overpayments


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In brief: OIG tells CMS to collect more overpayments, VGM announces Woman of the Year finalists

October 6, 2017HME News Staff

WASHINGTON - The MACs collected only 20% of Medicare overpayments referred by ZPICs and PSCs in 2014, says a new report from the Office of Inspector General.The ZPICs and PSCs referred $559 million in overpayments in 2014, but the MACs sought $482 million and collected only $96 million, according to the OIG.The ZPICs and PSCs send the highest number of referrals for Part B (60%) and DME (26%). They sent the highest dollar amount of referrals, however, for home health and hospice (43%), the OIG found.In...

HME Audit Key, HME Woman of The Year, OIG report, Overpayments


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Smart Talk

Overpayments: Create culture of compliance

August 22, 2016Josh Skora

A. In previous columns, I discussed how the 60-day overpayment rule presents a myriad of problems and questions that are sometimes difficult for an HME supplier to identify and address. However, the most effective remedy to overpayment problems is the implementation of and adherence to a robust compliance program. Overpayments will still arise, but the compliance program sets the stage for a corporate culture of compliance.The Affordable Care Act mandates that suppliers have compliance programs,...

Brown & Fortunato, Josh Skora, Overpayments


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CGS changes offset request process

July 26, 2016HME News Staff

NASHVILLE, Tenn. - CGS Administrators, the Jurisdiction B MAC, will no longer accept offset requests at the time of claim re-openings and adjustments, it said in a July 25 bulletin. Starting Aug. 1,suppliers who wish to have an overpayment withheld from future payments must wait for a demand letter. Upon receipt of the demand letter, the supplier may submit a request for immediate offset with, at minimum, a copy of the first page of the demand letter. Suppliers will have the option to submit a request...

CGS Administrators, Offset requests, Overpayments


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Smart Talk

Overpayments: Follow protocol

July 25, 2016Josh Skora

A. Typically, suppliers report and return overpayments to the DME MAC of jurisdiction. Each DME MAC has a standard overpayment refund form. The supplier simply provides information and submits a refund check. Suppliers must indicate a reason for the overpayment. A few of the available reasons are: billed in error, insufficient documentation, services not rendered and medical necessity. The refund is a dollar-for-dollar payment. No penalty is assessed.  On the other hand, in cases that involve...

Brown & Fortunato, Josh Skora, Overpayments


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Smart Talk

Overpayments: Extrapolate overpayments

June 21, 2016Josh Skora

A. My last column explained CMS's final rule clarifying the 60-day rule, which allows a supplier up to six months to quantify an overpayment once it's identified. Once the supplier quantifies the overpayment, it has 60 days to report and refund the overpayment. However, there is little, if any, guidance on how in-depth an investigation must be to quantify the scope of an overpayment.Take the following hypothetical: A supplier has a sales representative in each of the five states it conducts business....

60-Day Rule, Brown & Fortunato, Joshua Skora, Overpayments


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Overpayments: Exercise reasonable diligence

May 23, 2016Josh Skora

A. The Affordable Care Act requires a person who has received an overpayment to report and return the overpayment to the government.For HME providers, overpayments must be reported and returned within 60 days after the date on which the overpayment was identified. This led to many unanswered questions. What does “identified” mean? If a provider uncovers one overpaid claim, is it required to investigate all related claims? When does the 60-day clock start? How far back must the provider...

Brown & Fortunato, Josh Skora, Overpayments


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GAO pokes holes in CMS's MA audit program

May 10, 2016HME News Staff

WASHINGTON - The Government Accountability Office isn't pleased with CMS's progress in recovering substantial amounts of improper payments from Medicare Advantage organizations. The agency currently uses risk adjustment data validation audits to recover improper payments in the MA program. The GAO found that CMS's methodology does not result in the selection of contracts for audit that have the greatest potential for recovery of improper payments. The GAO also found “substantial delays”...

Audits, GAO, Medicare Advantage, Overpayments


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News

Providers must report overpayments going back six years

February 12, 2016HME News Staff

WASHINGTON - CMS has revised the look-back period for overpayments from 10 to six years, according to a final rule issued Feb. 11.Medicare Parts A and B healthcare providerswho discover Medicare overpayments within six years of the initial date reimbursementwas receivedmust report and repay them within 60 days to avoid liability under the False Claims Act, the rule states.“Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary...

Look-back period, Medicare, Overpayments


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