Jurisdiction J Part A MAC

Jurisdiction J (JJ) Medicare Advantage (MA) Overpayment Issue

8/3/18 - Delay in Claim Cancellation/Recoupment: Palmetto GBA and CMS have received a number of inquiries from providers and their representatives concerning provider appeal rights as well as information on how impacted providers may re-bill responsible MA plans. CMS is working to address these concerns and provide information to MA plans that will help them be better able to identify any rebilled claims from providers. So as to afford the agency with the time needed to develop complete guidance on these topics, CMS has requested that Palmetto GBA indefinitely delay its’ plans to auto-cancel claims for providers who have not submitted a valid exception request by August 17th. Additional information will be forthcoming in the next few weeks. Palmetto GBA encourages providers to monitor this message for updates as additional information becomes available concerning the delay. Read the CPIL and FAQs for more information.