Advocacy for Homecare Providers and HME/DME …



Wendy GagnonUnited Health CareDirector, National Durable Medical Equipment ProgramSeptember 27, 2018RE: Errors in Recent Recoupment Letters to DME ProvidersMs. Gagnon, I wanted to take the opportunity to discuss with you concerns raised to me as the Vice President of Payer Relations for the American Association for Homecare (AAHomecare). As we have discussed previously, AAHomecare is the national association representing durable medical equipment (DME) providers and manufacturers across the United States. Our membership consists of approximately 70% of DME providers, including large national and small local providers in all states in the country.I have been informed of recent recoupment letters sent to providers who participate in the UHC Medicare Advantage Network for claims for capped rental equipment. They have been informed this was due to the 25% payment reduction made for months 4-13 was not taken by United Health Care. However, providers are finding multiple errors in these recoupments and there are fundamental timely filing issues that make these recoupments invalid. United Health Care has only paid for 10 months of rental in lieu of the 13 months required in the Medicare capped rental program. Providers have been paid for the full purchase price with the current UHC payment methodology of 100% of the rates for 10 months. With recoupment of the 25% for months beyond 1-3, providers are allowed a total of 13 months of payments to meet the established purchase price. However, these recoupments are beyond the timely filing allowed by UHC for providers to file additional rental claims to meet full purchase price. Due to this, we would request that UHC eliminate current recoupments being made and correct claims processing technology and guidelines moving forward to eliminate this issue. Providers have given examples of claims recoupments occurring for months 1, 2, and 3 as well. This is outside of the payment reductions guidelines. Providers have also given examples of change in modality such as CPAP to BIPAP creating invalid recoupments as well for months 1, 2, and 3. As you can see, there are large fundamental issues with the current recoupment letters being submitted to providers. I would like to request that United Health Care immediately stop all recoupment activity related to this audit. If this cannot be accomplished I would request a meeting with United Health Care to discuss this further. I can be reached at Lauraw@ or at 336-451-1934.Sincerely, Laura L WilliardAmerican Association for Homecare Vice President of Payer Relations ................
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