Refunds related to claim denials due to Beneficiary Incarcerated Status

CMS initiated recoveries from providers and suppliers based on data that indicated a beneficiary was incarcerated on the date of service. Medicare identified previously paid claims that contain a date of service partially or fully overlapping a period when a beneficiary was apparently incarcerated based on information CMS receives from the Social Security Administration (SSA). As a result, a large number of overpayments were identified, demand letters released, and, in many cases, automatic recoupment of overpayments made. CMS has since learned that the information related to these periods of incarcerations was, in some cases, incomplete for CMS purposes. CMS is working to quickly identify claims that resulted in our recent recovery actions and take steps, as appropriate, to correct any inappropriate overpayment recoveries. Providers impacted by the incorrect incarcerated beneficiary claim denials have been receiving refunds through HIGLAS (Novitas’ financial system) without the associated remittance. Remittance advices or Medicare summary notices will not be issued for these reprocessed claims. Providers will receive a spreadsheet, currently expected later this month, with information needed to reconcile the accounts.