CMS Now Looking at Claims for Incarcerated Beneficiaries

CMS has teamed with the Social Security Administration (SSA) to identify overpayments on DMEPOS claims that the date of service indicates the patient was incarcerated at the time the product or service was provided. CMS has identified previously paid claims containing dates of service that overlap a period when the beneficiary was incarcerated based on information provided from the SSA. CMS generally does not pay for medical items and services provided to an incarcerated beneficiary.

From HME News:

“A large number of overpayments have been identified and demand letters released with appeals instructions,” the agency states in a bulletin.

CMS asks, however, that providers not file appeal requests at this time. Providers receiving demand letters for denial of claims because the beneficiary’s SSA record indicates incarceration on the date of service and who have reason to believe that the beneficiary was not incarcerated on the DOS, may wish to contact the beneficiary to gather as much information as possible. MORE

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