Physician Regulatory Issues Team (PRIT)
Physician Regulatory Issues Team (PRIT)
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Details for Identifying the Original Claim to Associate with a Refund or Recoupment Notice
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Shown below are the details for the item you selected from the list.
| Issue Name |
Identifying the Original Claim to Associate with a Refund or Recoupment Notice |
| Issue |
The Healthcare Billing Management Association complained to us that recoupment notices and refund notices do not identify explicitly the claim that they are associated with. The Medicare Remittance Notice clearly identifies the patient, service and date of service for every claim that is paid, none of this information is present however on recoupment and refund notices. These notices carry only a Medicare FCN number which Medicare uses for tracking. Practices attempt to identify the original claim either by attempting to match the FCN with earlier communication from Medicare about the claim or by writing a letter to the carrier requesting the HIC, service date and patient name. This step adds to costs both for the practice and for the carrier. |
| Status |
See below. |
| Date Issue Created |
01/15/2008 |
March 19: We are discussing the issue with CMS staff who have a detailed understanding of the claims processing system to determine what sort of patient identifying information might be included on recoupment and refund notices. June 11: We arranged a conference call with industry experts and CMS staff to explore the various ways to address this issue.
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Last Modified Date : 06/17/2008
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