Palmetto Recoupment Update

Meeting Scheduled with CMS

Bill Finerfrock, Executive Director


Palmetto Recoupment Update

As you know from my previous posts, NARHC continues to work on the Palmetto recoupment problem. To say that this is a mess would be an insult to anything I’ve previously described as “a mess.”

While I appreciate efforts by Palmetto to be responsive, the options they seem to have available for a fair resolution of this problem seem limited. For this reason, we are taking this issue to the highest levels at CMS.

On Thursday, July 5th, I will be meeting with the Deputy Administrator of CMS for Operations (#2 person) to discuss this problem and pursue alternative means of resolution. In particular, it is our belief that ultimately it is the Medicare Advantage plans that are liable for the payment of these claims. Unfortunately, we know that most of these claims will be subject to payment denial by these plans due to “timely filing” requirements. Failure to obtain recoupment of these monies from the Medicare Advantage Plans (either by the Clinics or CMS) means that MA Plans will have made millions in unearned profits as a result of this screw up by Cahaba.

We also believe RHCs will need more time to review the alleged improper payments and obtain the information necessary to properly challenge the assertion by Palmetto that the RHC received – and retained – monies improperly.

And speaking of time. Many RHCs have asked about their appeal rights or opportunities to formally challenge the Palmetto allegations. As we’ve previously noted, Palmetto has extended the effective date and provided an email address through which the RHC can submit information challenging their findings. But for some, this may not be enough. Particularly if you are an RHC that is facing a large recoupment.

Here is a link to a letter we obtained from a lawyer who works in this arena. This letter is for EDUCATION ONLY and does not constitute legal advice. As the letter notes, this firm has not been retained by NARHC. The letter seeks to highlight the legal basis for the actions by Palmetto and possible avenues for resolution of this on a clinic level.

Bill Finerfrock
NARHC Executive Director