MACs to Collect Annual Wellness Visit Overpayments

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Original story posted on: March 7, 2013

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Medicare administrative contractors (MACs) will recoup money for annual wellness visits erroneously paid to both facilities and physicians for the same visit.

CMS paid duplicate visits on the same patient on the same day because instructions to carriers wrongly permitted it. The erroneous claims date back to April 4, 2011, and could continue through March 31 because the fix won’t be implemented until April 1 of this year, according to transmittal 1190 published Feb. 15.

CMS confirmed to DecisionHealth that it would recoup the payment from whoever billed the claim second.

For more information, see transmittal 1190 at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1190OTN.pdf.

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About the Author

Karen Long is the editor of Physician Solutions for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

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KLong@decisionhealth.com

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