Closed Case List by Contractor - (Rev. 3, 11-22-00)

5.8 - Section V: Closed Case List by Contractor - (Rev. 3, 11-22-00) You may perform the same functions as in §5.5 (§II) above: Pending case list by contractor however, information will be provided for closed cases specific to the contractor ID number entered. 5.9 - Section VI: Report Menu - (Rev. 3, 11-22-00) Click here to view an exhibit of the Report Menu Screen. Click here to view an exhibit of the IRP Cases List Screen. Click here to view an exhibit of the View Case Detail Screen. Click here to view an exhibit of the Edit Case Detail Screen. Click here to view an exhibit of the Comments Screen. Click here to view an exhibit of the Provider Detail Screen. Click here to view an exhibit of the Provider Edit Detail Screen. Click here to view an exhibit of the View Allegations Screen. Click here to view an exhibit of the View Edit Allegations Screen. Click here to view an exhibit of the View Complainant Detail Screen. Click here to view an exhibit of the Case Report Screen. The report menu provides a variety of management reports in brief format and detailed format. Click on the report menu from the main IRP menu. Select the type of report desired from the following list: A. Brief List • All Cases; • Pending Cases; • Closed Cases; • Rewarded Cases; • Recovery From Ten Thousand Up; and • Notified But Not Rewarded B. Detail List • All Cases C. List By Contractor • All Cases- Brief; and • All Cases- Detailed EXHIBITS Exhibit 7 - Sample Letter for On-Site Reviews (Rev. 213, Issued: 06-29-07, Effective: 07-30-07, Implementation: 07-30-07) DATE: PROVIDER NAME: CONTRACTOR NAME: PROVIDER ADDRESS: CONTRACTOR ADDRESS: OPENING Dear _______: Thank you for your cooperation during the comprehensive medical review conducted at your facility on ___________. Based on this review we have determined that you have been overpaid. We hope the following information answers any questions you may have. REASON FOR REVIEW This review was conducted because our analysis of your billing data showed that your facility utilized ________ services at a rate of 50 percent more than that of your peer group. HOW THE OVERPAYMENT WAS DETERMINED A random sample of ________ claims processed from 01/01/98 to 06/30/98 was selected for review to determine if the services billed were reasonable and necessary and that all other requirements for Medicare coverage were met. Medical documentation for the selected claims was reviewed by our medical review staff. Our review found that some services you submitted were not reasonable and necessary as required by the Medicare statute or did not meet other Medicare coverage requirements. WHY YOU ARE RESPONSIBLE You are responsible for the overpayment if you knew or had reason to know that service(s) were not reasonable or necessary, and/or you did not follow correct procedures or use care in billing or receiving payment. The attachment identifies the specific claims that have been determined to be fully or partially non-covered, the specific reasons for denial, an explanation of why you are responsible for the incorrect payment and the amount of the overpayment. WHAT YOU SHOULD DO Please return the amount of the overpayment to us by ________ and no interest charge will be assessed. Make the check payable to Medicare Part A and send it with a copy of this letter to: Intermediary's Address IF YOU DO NOT REFUND WITHIN 30 DAYS: If you repay the overpayment within 30 days, you will not have to pay any interest charge. However, if you do not repay the amount within 30 days, interest will accrue from the date of this letter at the rate of _____ percent for each full 30-day period that payment is not made on time. On ________ we will automatically begin to recoup the overpayment amount against your pending claims. Recouped payments will be applied to the accrued interest first and then to the principal. If you believe that recoupment should not be put into effect, submit a Statement within 15 days of the date of this letter to the above address, giving the reason(s) why you feel this action should not be taken. We will review your documentation. However, this is not an appeal of the overpayment determination, and it will not delay recoupment. For copies of the applicable laws and regulations, please contact us at the address shown in our letterhead, to the attention of the __________ Department. APPEAL RIGHTS: If you disagree with the overpayment decision, you may file an appeal. An appeal is a review performed by people independent of those who have reviewed your claim so far. The first level of appeal is called a redetermination. You must file your request for a redetermination within 120 days of the date you receive this letter. Unless you show us otherwise, we assume you received this letter 5 days after the date of this letter. Please send your request for a redetermination to: Address to which redetermination request should be sent GENERAL PROBLEMS IDENTIFIED IN THE REVIEW AND/OR CORRECTIVE ACTIONS TO BE TAKEN This review has shown that you are not following national Medicare guidelines in submitting claims for necessary and reasonable ________ services. In addition, you have not followed the Provider Bulletins and letters sent to you regarding local medical review policies and specific problems that we have identified with your billing practices. Your future claims for _______ will be suspended for prepayment review until you correct your billing. If you have any questions regarding this matter, please contact _________ at ___________. Thank you in advance for your prompt attention to this matter. Sincerely,