Phase II Timely Filing Waiver (TFW) Demand Letters

Over the past few months, CMS and Palmetto GBA contacted Medicare Advantage (MA) Plans not wishing to make voluntary direct payments to the Medicare FFS program about the possibility of waiving their claims filing deadlines and/or otherwise giving payment consideration to MA overpayment claims. This would enable affected providers to rebill their claims to the MAs. More than 100 MA plans (XLSX, 17 KB) agreed to participate on a voluntary basis.

Since not all MA overpayments are included in the TFW process, each provider should carefully review its claims listing (attached to its letter) to identify which of its erroneous MA overpayments need to be (1) repaid to Medicare Fee For Service (FFS), and (2) pursued through the corresponding MA plans’ Point of Contact (POC).

On December 6, 2019, the TFW demand letters will be issued to affected providers. In addition to identifying FFS claims requiring repayment, these letters will identify participating MA plans and their designated POCs. Each TFW letter will include the following:

• Certain information applicable to the provider’s specific circumstance(s); for instance, whether or not the provider may receive a Phase III letter
• Claims listing that clearly delineates the MA overpayment claims that are encompassed by the letter’s demand for repayment
• An MA plan listing (and their designated POCs) that correspond to the provider’s FFS overpayment(s)

Current data on the total number of MAOs, participating MA Plans, and FFS claims that will be affected by the TFW process is indicated below:

Number of MAOs: 40
Number of MA Plans: 108
Number of Affected FFS Claims: 14,816 
 
Additional information is available in articles entitled “Medicare Advantage (MA) Plan Overpayments: Background” and “Medicare Advantage (MA) Plan Overpayments - Frequently Asked Questions (FAQs).” Questions may be addressed to MA.Response@palmettogba.com.