Physicians participating in Medicare may have to return money to the federal government. The Centers for Medicare and Medicaid Services (CMS) erroneously issued payments for claims processed after April 1, 2011, for which the patient has an unmet deductible and Medicare is the secondary payer. With liabilities being reassigned to the patient, physicians will likely have to seek payment from patients for any remaining deductible.
The Pennsylvania Medical Society (PAMED) wants to make its members aware of the situation so they are not caught off guard when they receive the explanation of benefits statement and a recoupment request from CMS.
If you are a PAMED member and have any questions, please contact our division of practice economics and payer relations, at (800) 228-7823, ext. 2644.
In addition, physical and occupational therapy claims processed after April 1 where Medicare is the secondary payer and a deductible is not met are being pended in the system and not being paid.
The problems are the result of an
internal change CMS implemented on April 1. CMS expects both of these issues to be resolved in November 2011.