August 29, 2014
Area(s) of Interest: Payor Issues and Reimbursement Practice Management
Recently, physicians may have started to receive TRICARE requests for refunds related to overpayment from the governmental health carrier. As a result, the California Medical Association’s Center for Economic Services has compiled a list of the most frequently asked questions and answers related to these TRICARE refund requests.
How long does TRICARE have to request a refund?
Pursuant to federal law, TRICARE is authorized to seek refunds of overpayment for dates of service as far back as 10 years, per Title 32: Subtitle A, Chapter: 1, Subchapter M, Part 199.11 - Overpayments recovery. (f) (6) (E) (v)).
How long does a physician practice have to respond to the overpayment request?
Physicians have 30 days to respond to the refund request. Failure to respond will result in the offset of monies against future payments until the full overpayment amount is received.
Can I bill the member for the balance?
Physicians should review the overpayment notice very carefully. In some instances, patients may be held financially responsible for the amounts owed.