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Medicare Part B

4/17/2007 12:00:00 AM

PCG/HMS Medicare Part B Audits


 For further information, contact: Deb Williams, Vice President, Reimbursement & Regulatory Compliance

M e m o r a n d u m

TO:                  Affiliate Executive Directors

                        Clinic Directors

                        Finance Directors

                        PCG Contact Person

FROM:            Deb Williams, Vice President, Reimbursement & Regulatory Compliance


DATE:             April 17, 2007

RE:                 PCG/HMS Medicare Part B Audits

We want all Affiliates to be aware of recent audits being conducted by Health Management Systems (HMS) – previously Public Consulting Group (PCG) – on Medicare Part B claims.  The audits were sent to providers regardless of the Medicare billing status, so we have been working to clarify the best course of action for all Affiliates.    

For those Affiliates who are Part A providers and are NOT Part B providers, you simply need to send a letter to HMS stating that you do not bill under Part B and therefore are not subject to this audit.  We have been working with HMS on this issue, and they have assured us that they will accept a letter from your agency indicating that you are NOT a Part B provider.

For Affiliates who are Part B providers, you will need to respond to the audit appropriately.  If you have any questions or need assistance in putting together the materials for your response, please feel free to call.

All Affiliates should be sure to keep an electronic report or other dated proof that you have responded to the audit in a timely manner.  Recently, there have been instances where responses to audits have not been received by HMS (or misplaced by them) and our Affiliates have had money recouped because they lacked the necessary proof that their response was indeed submitted on time. 

If you have any questions, please do not hesitate to contact me (518) 436-0178. 

*  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *  *

Deb Williams

Vice President, Reimbursement & Policy Development

Cerebral Palsy Associations of NYS

90 State Street, Suite 929

Albany, New York   12207

(518) 436-0178

Fax:  (518) 436-8619

[email protected]

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