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Interest Charged on Overpayments? Print E-mail
Written by Benjamin L. Frosch   
Monday, 16 December 2013 10:51

Medicare Q & A with Ben Frosch

Q:     I just received a letter from Medicare informing me of a substantial overpayment. My staff researched this issue and we concluded they are correct with the overpayment determination.  

The letter we received states that it is a follow-up letter. I never received the initial notification of an overpayment from Medicare. 
 
My question addresses the interest on this overpayment. What are the rules on Medicare assessing interest on an overpayment?

-Internist
Miami, FL

A:     Medicare does not charge interest on overpayments that are received within thirty-days. After the thirty day period, interest is assessed for the first thirty-day period and an additional thirty-day period. Interest continues to accrue for each subsequent thirty-day period for which payment is not received by Medicare.  When money is offset (withheld from Medicare payments), it is applied to the accrued interest first and then to the principal. The follow-up overpayment letter probably does not imply you have another thirty-day period to refund the amount nor does it prevent Medicare from withholding future payments after the thirty-day period has elapsed. If you do not refund the overpayment within forty-days from the date of the initial refund request letter, Medicare may initiate offsets and pursue other efforts of recovery of the identified overpayment.

The bottom line is, once you receive notification of the overpayment; return the monies as quick as possible. The overpayment is considered a debt owed to the United States Government and you can always appeal if you feel that Medicare is incorrect with the allegations of the overpayment or the interest payment. 

About the Author 
Mr. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation.  Got a question for Ben? Click Ask Ben. 

Last Updated on Monday, 16 December 2013 10:58
 
Locum Tenens and the 60 Day Rule Print E-mail
Written by Benjamin L. Frosch   
Wednesday, 18 September 2013 16:35

Medicare Q &A

Q:   We have a Locum Tenens physician who next week will be with us for sixty days. It is our understanding that sixty days is the "Medicare" cutoff for a Locum Tenens physician which allows us to use the Q6 modifier.   The provider enrollment process is very cumbersome and I was wondering if once our Locum Tenens physician reaches the sixty day period, can the Locum Tenens Physician take a day off and the sixty day Medicare period begin again?

-Office Manager

Palm Beach, FL

A:  If the regular physician requires services of a Locum Tenens physician for a period longer than sixty days, the substitute physician needs to enroll with the group practice. The Locum Tenens physician should complete a CMS 855R reassigning his/her benefits to the practice.   Otherwise, the substitute physician "taking a day off" is not a consideration in the Medicare guidelines of Locum Tenens for establishing the sixty day period.  

CMS guidelines state that a regular physician may bill for the services of a Locum Tenens physician providing that the following guidelines are met;

A.    The regular physician is unable to provide visit services.

B.    The substitute physician does not provide services over a continuous period longer than sixty-days.

C.    The Medicare beneficiary has arranged for or seeks to receive services from the regular physician.

D.    The regular physician pays the Locum Tenens for services on a per diem or similar fee for time basis.  

About the Author 
Mr. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation.  Got a question for Ben? Click Ask Ben.
 
Disruptive In-Office Emergency Visits Print E-mail
Written by Benjamin L. Frosch   
Monday, 09 September 2013 12:35

Medicare Q & A

Q:   We try to provide our patients with the highest quality of care. For our established patients, we have started to treat them on an "emergency" basis after hours at our office. Is it necessary for us to attach modifier 25 (indicating a significant, separately identifiable E/M visit on the same date as another procedure) to our follow-up visits in order to additionally bill Medicare procedure code 99058 (services provided on an emergency basis in the office, which disrupts other scheduled office services in addition to basic service)?

-Office Manager

Boca Raton, FL

A:  CPT code 99058 is not a recognized service that is billable to the Medicare program. The E&M follow-up visits will have to be billed according to the actual level of care that is provided to the patient. There is no additional reimbursement by Medicare for disruption of other scheduled services or after hour services in your office.

 About the Author 
Mr. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation.  Got a question for Ben? Click Ask Ben.

Last Updated on Saturday, 14 September 2013 15:39
 
Surgeon Inquires About Appeal Print E-mail
Written by Benjamin L. Frosch   
Friday, 30 August 2013 17:49

Medicare Q & A

Q.  I am a non-participating surgeon. I performed a surgery on a Medicare beneficiary that was very complex and time consuming.   Because the claim was submitted unassigned, the beneficiary received the payment which was very low for the surgery performed. The patient is elderly and would have difficulty filing an appeal. Can I file the appeal on behalf of the beneficiary?

-Surgeon

South Florida

A.  Yes, under certain circumstances. The beneficiary may complete an appointment of representation form (CMS 1696) which can be found at www.FCSO.com.

This form is used to authorize an individual to act as a beneficiary's representative in connection with a Medicare appeal. As a representative, you would be able to help your Medicare patient during the processing of the claim and any subsequent appeals. 

About the Author
Mr. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation.  Got a question for Ben? Click Ask Ben.
 
Cardiologist Inquires About Deadlines for Submitting Medicare Claims Print E-mail
Written by Benjamin L. Frosch   
Friday, 23 August 2013 09:36

Medicare Q & A


Q:   I am a solo practitioner who specializes in cardiology. One of the tests that I perform in my office is echocardiography.   During very busy periods, I may not provide a full interpretation and report of my echocardiograms for a few months. I understand that I cannot bill Medicare until the service is complete and therefore wait until I have provided a full interpretation and report. As a result, I may not bill Medicare for those services for over a year period. Has there been a change with respect to the time period of submitting claims to Medicare?

-Cardiologist

 Tampa, Fl

A:   As a result of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) will only pay claims for services rendered within one year of the actual date of service. Claims received later than one calendar year beyond the date of service will be denied by Medicare. Therefore, you should not submit claims to Medicare that are more than one year old or that reimbursement will be lost. 

Another point that you should consider is that by taking so much time to interpret these echocardiograms, Medicare could take the position that these services were not medically reasonable and necessary in treating and managing the patient.   So even if you submit claims for echocardiography to Medicare within a year of performing the service, you may still have an issue with Medicare pertaining to why you waited so long to interpret those echocardiograms.

About the Author
Mr. Frosch is the President of Frosch Medical Consultants, Inc. in Plantation.  Got a question for Ben? Click Ask Ben.  

Last Updated on Saturday, 24 August 2013 10:25
 
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