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Program Integrity Manual Updated for Identity Theft and Hospice Aggregate Cap Liability

Posted on Monday, March 9, 2020 1:02 PM

CMS has released a new transmittal that updates the chapter of the Program Integrity Manual to address coordination between Medicare Administrative Contractors (MAC) and Unified Program Integrity Contractors (UPIC) in situations of hospice aggregate cap liabilities, as well as addressing Medicare liabilities in situations of provider identity theft.

The Program Integrity contractor reviews hospices have overlapped with the MAC review of the benefit cap liability for those same hospices, resulting in a potential double recovery for the government.

CMS also updated the existing Identify Theft Protections and Victimized Provider Process section. CMS considers a “compromised number” to be a beneficiary or provider/supplier number that has been stolen and used by unauthorized entities or individuals to submit claims to, i.e., bill, the Medicare program.

Click here to read the transmittal.


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