In February, we began receiving refund requests from CMS for very old charges. All of these requests have come to us from WPS, the current Medicare intermediary. When we first began to receive them and inquired the cause or reason, we were told these refunds were in process but not completed by Wheatland’s, the previous Medicare intermediary, when the switch occurred. When we pressed for details, WPS was not able to provide any.
We do have a list of charges and patients making up the requested amount. As we have pulled each charge and looked at each original payment, we noticed most were charges processed without a modifier or with the wrong one. Others were missing a secondary or medical necessity supporting diagnosis.
Our office is pulling each claim and the explanation of benefits. After completing a redetermination letter, highlighting what we believe is wrong with the records, we are submitting this request for repayment. We are comfortable we will be able to recover this money for you. However, in an effort to avoid any interest penalties, you may notice a refund amount included on your invoice this month.
Some clients have received multiple letters while most have received only one to date. After visiting with WPS and being told they “received literally thousands of boxes containing these audits”, we are not able to assure you this is all we will receive. What we do know is our clients are not the only providers receiving these letters.
Should you have questions, please do not hesitate to contact me.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
No Comments