Regulatory & Billing Update
CCA Update: Recovery Notices Paused; UD Modifier Issues Ongoing
Recent discussions with Commonwealth Care Alliance leadership clarify next steps on recovery notices and ongoing billing concerns.
The Home Care Alliance recently connected with Commonwealth Care Alliance (CCA) leadership to address ongoing concerns raised by members related to recovery notices and billing discrepancies.
CCA confirmed that prior recovery notices tied to inpatient overlap and T1502 claims are being reconsidered. Providers will receive a formal letter indicating that no action is required at this time, and that any previously recouped funds related to these notices will be returned. If recovery is ultimately warranted, a new notification will be issued.
Recovery notices tied to inpatient overlap and T1502 claims are currently paused, with refunds expected for previously recouped funds.
Separately, CCA indicated that overpayment notices related to the UD modifier (visits 31+ days post-hospitalization) are not being rescinded. However, a system limitation was acknowledged in cases where a patient had a hospital stay within 30 days of the original admission, which may have led to inaccurate identification of UD modifier requirements during audits.
Providers who believe claims were incorrectly flagged may dispute those claims with CCA. If the UD modifier should have been applied, claims should be rebilled accordingly.
CCA acknowledged discrepancies in some audits and encourages providers to dispute incorrect claims and rebill where appropriate.
Concerns were also raised regarding recoupments occurring without notice and discrepancies in amounts. CCA indicated they will work with providers individually to resolve these issues.
