CMS issued a special edition MLN Matters meant to be effective August 1, 2015. The guidance reflects CMS instructions to Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) regarding the scope of review for redeterminations and reconsiderations of certain claims. CMS acknowledges its concern that MACs and QICs were using their discretion to conduct … Continue Reading
Prior to passage of the Medicare Modernization Act of 2003 (MMA), CMS was not restricted in recouping overpayments, despite the provider’s ongoing appeal rights. Finally, as of November 16, 2009, CMS will implement new rules required by MMA to restrict immediate recoupment. Section 1892(f) of the Social Security Act prohibits recoupment of overpayment during a supplier … Continue Reading
