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Printed Date: 9/22/2015
In the course of conducting audits, Palmetto GBA/Railroad Medicare’s Benefit Integrity Unit (BIU) has found many providers fail to respond to records requests. If the BIU does not receive a response to a records request within 30 calendar days from the date of the request, each selected claim will be denied as not reasonable and necessary. All previously paid funds will be recouped, and overpayments will be established. Interest will accrue for each overpayment every 30 days. If overpayments are not paid timely, offset from pending and future claims will begin on the 41st day from the set up date.
Providers may request an appeal of an overpayment; however, individuals who supply records the first time around may avoid unnecessary denials and debt collections.
Medicare Administrative Contractors (MAC) and the Railroad Retirement Board Specialty MAC (RRB SMAC) have the authority to collect records per the following Social Security Act regulations:
When furnishing your documentation to the BIU, please keep the following in mind:
Not all claims are denied for non-response. Other claim denials may include:
Regardless of the reason, all BIU denials will result in overpayments being set up, and the provider will be responsible for the charges.
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Last Updated: 10/09/2018