HNS PolicyThis policy survives termination of the HNS Practitioner's Participation Agreement.
Payments to Which the Provider is Not Entitled
HNS Policies:
Provider Errors (Inadvertent Errors)
HNS Policy: If a contracted health care professional receives a payment for a service to which he/she is not entitled, due to an inadvertent error by the contracted health care professional, and when the filing of a "corrected claim" by the contracted health care professional is the appropriate course of action to resolve the issue, the contracted health care professional shall file a "corrected claim" and shall do so within 15 days of the date he/she becomes aware of the overpayment.
Payer Recoupments As a general rule, when a payor discovers it has made a payment to provider to which he/she was not entitled, the payor will recoup those monies from future payments owed to the provider.
HNS Policy: If HNS receives notice from a payor that a refund is due, or otherwise determines the provider has received monies to which he/she is not entitled, as a general rule, HNS shall recoup those monies from subsequent payments otherwise due to the provider who received the overpayment. However, HNS, at its sole discretion, reserves the right to require the provider to issue a certified check or money order, to HNS, or to the payor, for the full amount of the overpayment, and providers shall promptly comply with any such request.
Contracted health care professionals shall allow HNS, and, as applicable, contracted payors, to recoup the total amount of any overpayments, from future HNS payments, until the amount due has been repaid.
If the individual provider to whom the payment was issued is an employee of another HNS provider, or otherwise associated with a practice with a different EIN from the EIN associated with the initial payment, HNS reserves the right to recoup the funds from either the physician to whom the payment was issued OR from another provider under whose EIN the payment was reported.
HNS, in order to recoup the entire amount of the overpayment from the provider, may recoup up to the total amount of the recoupment, from any and all future payments HNS receives, from any payor, which would otherwise be owed to the provider.
Recovery of Payments after Termination
HNS Policy: Providers shall remain liable for overpayments that occur as a result of services provided prior to termination. Should a payor recoup monies from HNS, or request the repayment of monies by HNS, associated with services provided by a contracted health care professional who is no longer an HNS participating provider, HNS reserves the right to pursue all remedies available at law it believes necessary or appropriate, in connection with collecting those funds from the provider.
Refunds to Patients
HNS Policy: If HNS or a payor determines a provider has received payments from a patient to which he/she is not entitled, and determined those fees must be refunded to the patient, contracted health care providers must refund those monies to the patient within 10 days of the date HNS notifies the provider that a refund must be issued.
HNS may require the contracted health care professional to provide HNS with a copy of the check issued to the patient, and if so, the provider shall comply with that request.
Refunds to HNS
HNS Policy: Unless specifically instructed to do so by HNS, contracted health care professionals shall NOT issue refund checks, either directly to HNS, or to an HNS contracted payor.
Providers shall resolve repayment of funds to which they are not entitled pursuant to these policies, and/or to specific directives issued by HNS.
Underpayments
If a claim (or claims) was adjudicated incorrectly by the payor, and the EOB/NOP reflects less than the contracted allowable, contact your HNS Service Representative for assistance in resolving the issue.
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