Automated Medicare recovery process being updated

Blue Cross Blue Shield of Michigan is updating its automated Medicare recovery process, effective Sept. 1, 2016.

Blue Cross only pursues recovery of claims that fall within Medicare’s timely filing guidelines of 365 days from the date of service. Currently, Blue Cross recovers claims with dates of service that are within 10 months of the date. Our updated process will recover dates of service within 11 months of the date of the member’s change in eligibility. This change will be effective Sept. 1, 2016.

This doesn’t apply to Medicare Advantage recovery efforts.

The current recovery process is:

• If a recovery is necessary, Blue Cross will create an account receivable for the money due.
• Providers will receive an account receivable notice on their weekly vouchers if recoveries are needed, indicating our intent to recover the claims payments.
• Providers will need to rebill the claims to Medicare within the time frame specified by Medicare to receive the primary payments.
• If necessary, providers can work with their provider consultants to resolve any disputed recoveries.

Note to hospitals: For hospitals receiving weekly Blue Cross interim payments, or BIPs, an Account Receivables Created section will appear on their vouchers and will serve as notification of payment reductions. Reductions should be applied when the account receivable is created, as these adjustments won’t be deducted or reported in the Account Receivables Applied section of future vouchers.