Immediate Recoupment for Fee for Service Claims Overpayments

Good Morning MFS Bloggers, Effective July 1, 2012, CMS Change Request (CR) 7688 implements a standard 'immediate recoupment' process that gives providers the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the initial demand letter date.

Background
Currently, Medicare Contractors begin recoupment of an overpayment on day 41 from the date of the initial demand letter. Interest accrues and assesses on an overpayment if not paid in full by day 30.

Key Points
The 'immediate recoupment' process implemented in CR 7688 allows providers to request that recoupment begin prior to day 41. Providers who elect this option may avoid paying interest if the overpayment is recouped in full prior to day 31.
Key to understanding this change is that providers who request an immediate recoupment must realize it is considered a voluntary repayment. Also, note the following:
1. Providers who choose immediate recoupment must do so in writing to the contractors
2. The request may be for:
• A one-time request for a specific demanded overpayment (the total amount of the demanded overpayment). A permanent request for the specific demanded overpayment and all future overpayments
3. The request may be submitted via regular mail, fax or e-mail and the request must include the Provider's name, contact phone number, Medicare number and/or National Provider Identifier (NPI), Provider or Chief Financial Officer's signature, demand letter number and what option the provider is requesting
4. By choosing immediate recoupment, providers must understand that they are waiving their rights to interest under Section 935 of the Medicare Modernization Act (MMA) should the overpayment be reversed at the Administration Law Judge level (AU) or subsequent higher levels
5. Providers can terminate the immediate recoupment process at anytime. The request to terminate must be in writing.

Providers should note that Medicare Contractors will not consider any recoupment after Qualified Independent Contractor (QIC) proceedings (30 days after a QIC decision) as voluntary payments. Medicare Contractors will follow the rules proscribed by Section 935 of the MMA for all recoupment activity after a QIC decision. These rules are explained in Chapter 3, Section 200 of the Medicare Financial Management Manual that is available at www.cms.gov/manuals/downloads/fin106c03.pdf on the Centers for Medicare & Medicaid Services (CMS) Web site

CMS POSTS REVISIONS TO OASIS-C MANUALS

Good Morning MFS Bloggers, CMS recently revised the its OASIS-C Guidance Manual for Calendar Year 2011. The revisions and updated errata list are now available on the CMS site, https://www.cms.gov/HomeHealthQualityInits/14_HHQIOASISUserManual.asp, and are available for download:

OASIS-C Guidance Manual Errata (December 2011)
and OASIS-C Guidance Manual (December 2011)

Have a great day!

Chris

DECEMBER 8, 2011: CMS CLARIFIES FACE-TO-FACE REQUIREMENTS

Good Morning MFS Bloggers, In a December 8, 2011 CMS Listserv Update, CMS clarified its policy on its face-to-face documentation requirements. CMS stated as follows: “In the case of patients admitted to home health following an acute or post-acute stay, the BPM language allows for one physician to sign the certification and face-to-face documentation, while a different physician can sign the plan of care. If the face-to-face encounter documentation and the CMS-485 form collectively satisfy all of the certification and plan of care content requirements as defined in Chapter 7 Section 30 of the BPM, Medicare contractors shall accept a CMS-485 form signed by the community physician who assumes oversight of the patient’s home healthcare with an addendum containing the face-to-face encounter documentation requirements signed by a physician who cared for the patient in an acute or post-acute setting, to satisfy the certification, face-to-face encounter, and plan of care requirements. In this scenario, the certifying physician is the acute or post-acute physician, has initiated content on the CMS-485, and has completed and signed the face-to-face encounter documentation. The physician who signs the CMS-485 assumes care for the patient’s home healthcare.
Additionally, it has come to our attention that some contractors are denying claims for failure of the acute or post-acute physician to identify the community physician who will assume care for the patient. CMS has not mandated the acute or post-acute physician to follow a specific documentation protocol to hand-off a patient to the community physician.
For claims that have been previously denied for not having met face-to-face requirements in the scenarios described above, upon receiving a request from the home health agency for reopening of the claim, CMS contractors have been instructed to reopen and determine if face-to-face requirements have been met, due to their meeting the criteria described in the instruction described above. However, a determination that face-to-face requirements have been met would not result in an automatic pay of the claim. Contractors must subsequently perform a complete and full review to determine if payment should be made.
In summary, assuming all content requirements of the certification and the face-to-face documentation are otherwise met, in the case of patients admitted to home health following an acute or post-acute stay, Medicare contractors have been instructed to accept a CMS-485 form signed by the community physician who assumes oversight of the patient’s home healthcare with an addendum containing the face-to-face encounter documentation requirements signed by a physician who cared for the patient in an acute or post-acute setting, to satisfy the requirement of the certification, (which now includes the face-to-face encounter).”

Wishing you all a happy and healthy 2012.
Christopher A. Parrella, JD, CHC, CPC, CPCO