Keep 60% Pay by Acting on Medicare Advantage Overpayments by Feb

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Keep 60% Pay by Acting on Medicare Advantage Overpayments by Feb

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Medicare Advantage Overpayments

If your physicians participate in Medicare Advantage Plans, keep a sharp eye on the mail.

The final Medicare Advantage Overpayments letter is being mailed to practices the first week of January, and it contains a time-sensitive CMS settlement offer that you must act on this Winter or risk significant financial losses.

Medicare Advantage Overpayments Letters

CMS and Palmetto GBA are ready to initiate phase III of the Medicare Advantage Overpayments resolution in the form of a third letter, due to be mailed on or around January 3. You should already be aware of the other two correspondences:

  • Phase I, the first letter, was sent in November 2019 and identified the Medicare Advantage Overpayments that were voluntarily resolved by numerous MAOs.
  • Phase II, the second letter, was sent in early December 2019 and notified providers which overpayments they could re-bill, identified the Fee-for-Service (FFS) claims that required repayment, and provided Medicare Advantage plan point of contacts (POCs).

But even with $26 million in overpaid funds voluntarily repaid — and 133,000 erroneous claims resolved, there are still about $12 million unresolved Medicare Advantage Overpayments.

Who Will Receive A Third Letter?

If your Medicare Advantage Organization (MAO) is one who elected not to voluntary repay or rebill your claims, you should expect a third letter early January. The Phase III letter addresses these unresolved overpayments and contains a settlement offer from CMS for the unresolved Medicare Advantage Overpayment claims.

It will also have a listing of the specific claims included in the CMS settlement offer. Easily Identify Medicare Advantage Overpayments Final Letter Due to the time-sensitive nature of the Medicare Advantage Overpayments third letter, you can’t afford to miss it or overlook your required action. Here’s how you can identify the Phase III letter:

  • It will be mailed in an envelope from Medicare.
  • It will arrive addressed “ATTN: Chief Executive Officer” noted under the provider’s business address in all red capital letters.
  • It will be printed on CMS letterhead.

Respond Promptly to Medicare Advantage Overpayments Third Letter

Your prompt response to the Medicare Advantage Overpayments third letter is critical. You only have sixty days to respond and accept the settlement, and you have a weighty decision to make. Here are your options:

  • Accept the CMS settlement offer. If you accept, you will need to repay Medicare 40 percent of your total Medicare Advantage overpayments and retain 60 percent of the original payments. The balance you need to repay will be specified in the settlement offer.
  • Don’t accept the CMS settlement offer. If you decline the settlement or don’t respond, you’ll receive a Medicare demand letter requesting repayment to FFS for the full balance of the Medicare Advantage overpayments that you’ll need to repay. You do have the option to pursue appeals on any of these claims.

Reminder: Recipients of this time-sensitive letter will have just sixty days to respond. Input a calendar reminder now for approximately the middle to end of February, which will be close to the deadline. Keep in mind, not all providers will receive this third Medicare Advantage Overpayments letter — it’s only being sent to providers who are affected by Phase III of CMS’s Medicare Advantage Overpayments resolution plan. Your practice should respond to the specifics of the final letter.

Regarding which claims are still outstanding, the first letter should have indicated what claimed were redeemed already through the voluntary MAO payments. If you don’t see a particular claim on one of the letters then it’s not considered to be part of the Medicare Advantage Overpayments. For more information on the Medicare Advantage Overpayments, see the Palmetto GBA Medicare Advantage Plan Overpayments Frequently Asked Questions.

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