The Ohio Department of Medicaid is in the process of sending “Post-Payment Claims Overpayment Review” reports for fiscal year 2011 (July 1, 2010 through June 30, 2011) to most nursing facility and ICF/IID providers.  We wanted to share some important information with you, as we are seeing many errors in the overpayment reports.

Providers must respond to these notices within 30 days.  In most cases, providers should choose the “bureau-level resolution process.”  While Medicaid suggests all supporting documentation be sent in with the “bureau-level” request, it can be sent at a later date if additional time is needed to locate the documentation.

As we mentioned above, we are seeing numerous errors, with some proposed amounts much higher than amounts paid back in prior years.  Just a few of the examples we have seen include a proposed overpayment in excess of $1.5 million for a single nursing facility and an overpayment in excess of $250,000 for a provider that has historically settled for less than $10,000.  In many cases, the reports propose to take back days for the full fiscal year for multiple residents of a facility, even in cases in which some of those residents had resided in the facility for many years without issue.  Providers will need to submit supporting documentation to prove Medicaid eligibility and level of care to remove claims from the overpayment report.

We cannot stress enough the importance of responding to these notices within 30 days.  If a provider does not respond, ODM will automatically recoup the proposed overpayment, no matter the amount.  Further, the “Post-Payment Claims Overpayment Reviews” are not subject to Chapter 119 of the Ohio Revised Code, and as a result, failure to respond to the notice cannot be appealed.  For chain organizations, the reports may be sent directly to your facilities.  It is very important to ensure all of your notices are received.

Please contact an HW Healthcare Advisor if you have any questions or concerns.