Will Medicare Negotiate Final Demand Letters?

Posted by Kendell Gracey on Apr 22, 2015 6:00:00 AM

lori-0005647003-smallwwwNo one wants to pay more for something than absolutely necessary. This applies to Medicare compliance just as it does to a trip to your local supermarket. However, Medicare isn’t going to put things “on sale” or arbitrarily lower the demand amount to improve customer satisfaction.

So, the short answer to the title question is “no.” However, an option is available for lowering the amount reimbursed to Medicare depending on the circumstance. Here’s how:

Appeals on Unrelated Payments

The most common method for reducing Medicare's reimbursement on a liability, no-fault or workers’ comp claim is to weed out any items Medicare paid for that do not directly relate to the injury in question.

Often, these items appear on Medicare's initial Conditional Payment Letter (CPL) because standard treatments were administered while the patient was being treated for related injuries.

For instance, while receiving treatment for a concussion, a patient might be kept overnight for observation. The following morning, the patient receives standard high blood pressure and diabetes pills along with a check-in from the neurologist assigned to their case.

While all of these services appear on the medical bill, and Medicare may pay all of them originally, the pills the patient received had nothing to do with the injury. In this case, Medicare is not legitimately entitled to reimbursement of these pills from the individual's P&C insurance.

While this is a simplified example, imagine the potential unrelated charges on medium to large sized claims. They quickly run into the thousands of dollars.

So, to quickly recap, can you call Medicare and negotiate a lower reimbursement amount on their FDL?

No.

But, there are legitimate ways to ensure that Medicare receives exactly what they require and not a penny more. If you'd like to discuss how Flagship can assist, especially in regards to vetting itemized claims prior to receiving an FDL, contact us and we'll be glad to talk with you.

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Topics: Compliance