November 13, 2018: Negative Payment Takebacks
November 13, 2018: Attention Institutional Providers: It was found that the Michigan Department of Health and Human Services (MDHHS) has incorrectly been reimbursing claims secondary to Medicare when a negative dollar amount is reported as payment. MDHHS has taken back claims with dates of service from 2014 to current, these claims can be identified with the claim note “OICU Recovery due to incorrect reporting of Medicare (negative OI payment are not allowed)” on the credited TCN.
Any newly submitted claims with a negative payment amount reported from Medicare will be denied per the Medicaid policy below:
Medicaid Provider Manual >>> Billing and Reimbursement for Institutional Providers >>> Section 6.2.G
For Medicaid reimbursement, the amount billed for services does not equal the sum of the coinsurance and deductible items. It must be calculated as the gross hospital charges minus all Medicare payments, minus other insurance payments, and minus any patient-pay and/or copayment amount. If a claim is submitted with the amount billed equal to zero, other payment greater than or equal to Medicaid’s payment, or a negative amount, Medicaid does not make a payment. If there is a balance to be billed to Medicaid, the hospital may bill Medicaid for covered services only.