tci Medicare Compliance & Reimbursement - 2008 Issue 31

Reader Question: HHAs Won't Get Full Episode Payment For MA Patients

You'll have to hand back payments you've received in error, a CMS official warns. Question: I hope you can shed some additional light on this subject for us...We are having issues when a patient changes payer sources from traditional Medicare to a managed care plan. The intermediary is actually applying a PEP to the traditional Medicare claim and we do not believe the regulatory language allows this or even speaks to managed care plans.Answer: Consultant M. Aaron Little with BKD in Springfield, MO points out that the Medicare Claims Processing Manual states: "In cases where an HHA...

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