Dear List,
We have had 3 claims in the past 3 weeks denied by Medicare Part B when fit
on the date of discharge from a hospital and discharged to their home (not
another Part A facility).
2 of the claims were originally paid by Medicare, but then we got a
recoupment letter saying that “The claim was paid in error.” and “Not paid
separately when the patient is an inpatient.” Again, these patients were
discharged from the hospital to their homes the day of fit, thus we are
supposed to bill Part B and not the hospital. When we called Medicare they
said that it was a glitch, but how can it be a glitch if it was paid first?
1 of the claims was denied up front for the same reason that the patient
was an inpatient.
Medicare is now reprocessing our claims and we refused to give the money
back because we do not feel that we are in error.
Just a warning to all of you. Stick to your guns. This may be happening
more often and it feels like they are doing it just to see who does not pay
attention and just gives the money back or does not fight. If you are in
the right, stand up for yourself and your money.
For those of you wondering, the claims were for resting hand splints, a
knee brace, and a TLSO.
Rachel Sidle, CPO, LPO
Memphis, TN
