Ok list, here’s a good one for you & please beware!
Provided a transtibial prosthesis to a Medicare beneficiary. Got paid for all procedure codes for said prosthesis & supplies except for a miscellaneous code (which was explained, Dr documented & medically necessary). Appealed the denial of payment for the miscellaneous code. Received a notice shortly thereafter that the entire device was “provided fraudulently” & a request for partial refunds for most of the codes, but not full amounts & not all codes(!?). On the phone, no one could figure out what was going on & no one could explain. Finally, someone tells us: “That’s our policy now; when you appeal a denied code, we want all payments back so we can review the entire claim”.    Let that sink in.
Not ok, but then why are only partial repayments requested & what do we do now? My office manager was told to repay everything that is requested in writing & to expect more requests.
Seriously!??? Are we now being penalized for appealing their decisions &/or clerical errors????!
This system is becoming more & more broken.
Rick Milen, CPO/LPennsylvania
