Department of Health and Human Services Office of The Inspector General: Medicare made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments Report


In a recent Office of Inspector General’s (OIG) final report, “Medicare Made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments” (A-07-19-05117), the OIG identified that Medicare paid for services for which physicians reported monthly end-stage renal disease (ESRD) related billing codes more than once for the same beneficiary, for the same calendar month, resulting in overpayments. The identified overpayments included instances in which different physicians reported and/or the same physician reported ESRD monthly capitation codes during the same calendar month.

Providers that bill ESRD monthly capitation payment services are encouraged to review the OIG report in its entirety, share the information with the appropriate staff and if an overpayment demand letter is received because two ESRD monthly capitation payment services were billed and paid, follow the instructions in the overpayment letter and refund the amount identified. Any overpayment demand letter associated with the referenced OIG report will include a reference to the Office of the Inspector General. Providers that receive overpayment demand letters based on the OIG review are instructed that they must refund all improperly collected deductibles and/or coinsurance amounts associated with the identified incorrectly paid claim.

Full details on billing ESRD monthly capitation services can be found on Palmetto GBA’s Nephrology webpages.

Jurisdiction J Part B — Nephrology

Jurisdiction M Part B — Nephrology

Office of the Inspector General Report: Medicare Made Millions of Dollars in Overpayments for End-Stage Renal Disease Monthly Capitation Payments





Last Updated: 06/30/2021