Incarcerated Beneficiary Update - CMS

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

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