by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Oct 16th, 2014 - Reviewed/Updated Jan 30th
In 2013, CMS initiated recoveries from providers and suppliers based on data that indicated a beneficiary was incarcerated on the date of service. CMS subsequently discovered that some of the data used was incomplete. Since some of these recoveries might have been erroneous, CMS initiated refunds. Most of the incarcerated beneficiary erroneous overpayment refunds were issued before the end of December 2013, with some subsequent refunds on situations that had been appealed. The process CMS used to expedite the refunds precluded the issuance of a detailed remittance advice (RA). However, CMS mailed a spreadsheet to each impacted provider, which listed each claim that was being refunded.
Some of the overpayments for incarcerated beneficiaries were valid and were not refunded. If you believe that an incarcerated beneficiary related claim was erroneously designated as an overpayment, with funds recovered and not subsequently refunded, you may request that your Medicare Administrative Contractor (MAC) reopen the claim.
If you have received an RA from your MAC indicating a Temporary Allowance (TA) but no other documentation (such as a separate letter), you may contact your MAC and request an explanation.
For more information:
- MLN Matters® Article MM8488, “Revised Beneficiary Liability and Messages Associated with Denials for Claims for Services Furnished to Incarcerated Beneficiaries
- “Medicare Coverage of Items and Services Furnished to Beneficiaries in Custody Under a Penal Authority” Fact Sheet
References/Resources
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.