Once an overpayment has been determined, providers are required to repay the debt. Complete the return of monies voluntary refund form (see below) and attach a check for the amount. Specific data such as patient name, Medicare ID # and Medicare claim number must be included for claim correction and remittance revision, where appeal rights are afforded. If this data is not returned and Medicare is unable to correct records, claim(s) included in the refund may be identified as an overpayment and demanded in the future.

Yes. Medicare requires the signature of the beneficiary, or that of his or her representative, for both the purpose of accepting assignment and submitting a claim to Medicare. The IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 10, section 20.1.2 lists multiple options relating to how and when authorization can be obtained and submitted.

Reference

Medicare Part B pays only for physician services not performed for the hospice-related condition or paid under arrangement with a hospice entity. Services related to the terminal condition are billed by the hospice facility to the appropriate home health intermediary (Part A). 

Electing or revoking the Medicare hospice benefit is the beneficiary’s choice. The patient or their representative may elect or revoke Medicare hospice care at any time in writing. The hospice entity cannot revoke the beneficiary’s election, nor request or demand that the patient revoke their election. If the patient revokes their hospice election, Medicare coverage of all benefits waived when hospice care was initially elected resumes under the original Medicare program. 

No. Although the injections are billed under the supervising physician’s NPI, he or she is not required to see the patient or document any notes in the patient’s medical record.

A service that is billed as “incident to” is one that is furnished as an incidental but integral part of the physician’s professional services in the course of the diagnosis or treatment of the patient’s injury or illness.

Therefore, in order to bill for injections provided “incident to” by an NP or NPP, the service(s) must be:

TPE review verifies that services are performed and billed appropriately based on current guidelines, including but not limited to LCDs, local coverage articles, NCDs, IOMs, and the Social Security Act (SSA).

When a provider determines that a Medicare overpayment exists, the following steps must occur.

Complete the Return of Monies Voluntary Refund Form

In order to ensure the MSP refund is properly processed, a copy of the other insurer’s EOB and/or payment information (i.e., a copy of the check) is required to calculate the Medicare Secondary payment. When the Medicare Secondary payment is calculated, it will determine if the refund amount is correct or there is an additional balance due.

First Coast accepts medical records via: