Repetitive Ambulance Patient Mileage Overpayments
As some of you may be aware, your local Medicare carrier, Palmetto GBA, has incorrectly allowed payment for certain mileage charges, for repetitive ambulance patients. Typically, overpayments would have to be refunded within 60 days of becoming aware of them. However, Palmetto GBA has issued specific instructions to ambulance providers to repay these specific repetitive ambulance patient overpayments.
Palmetto GBA is using an internal process to identify mileage “overpayments” for repetitive ambulance patients. Palmetto is currently in the process of mailing providers a written request for repayment. The schedule for those notices is yet to be determined. Palmetto GBA is instructing providers to “refund the payment upon receipt of the overpayment letter that will be sent as mass adjustments are periodically performed.”
In this situation, it may be acceptable to await Palmetto’s request for payment. During the time leading up to a notice being received, providers can continue to work toward a prior authorization for the patient or time frame in question. A prior authorization approval could change the course of Palmetto’s effort to collect these overpayments.
As a general reminder, Medicare billing rules require providers to initiate a repayment process on their own for erroneous payments. This process has to be initiated within 60 days of becoming aware of the payment. It appears that Palmetto GBA is handling the notifications internally for this specific issue but this may not relieve providers of their obligations to report and refund these payments later. This applies to all patients, not just repetitive ambulance patients.
Obviously, this issue provides another layer of complexity to the prior authorization issue. Providers are encouraged to take the time to educate themselves using the articles we have written on this subject here. We can answer your questions by telephone and email, but this is not a substitute for having a thorough understanding of how the Medicare rules work. We can not give you that in an eMail or conversation. This business requires ongoing study and discussion among your peers. Feel free to read a couple of the published articles here on the subject, then give us a call and we can discuss the nuances of the prior authorization process with you. This is not a simple matter by any means. If you want to read Palmetto GBA’s announcement on this matter, follow the link below.
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Keith A. Waycaster, CEO