Can someone please help me and tell me if you've seen this or have a suggestion on how to handle this?!
The first week of September I received a letter from Tricare stating that they are recouping several claims. The explanation states "An overpayment has been made on the below referenced claims. The original payment was based upon an error in the system logic: therefore, a recoupment is being initiated for the overpayment amount." I called Tricare and was told that there was a recent DME POS update that resulted in overpayments. He could explain what that meant and could offer nothing beyond that. I told him that I saw a notice on the Tricare website from 6/26/19 stating that there was an issue with DME capped rental items being reimbursed incorrectly. I asked if that could be the issue and he did not know and said to send in a letter and ask for an explanation and mention that we do not offer DME rentals. I sent the letter to the address he indicated and haven't received a response and that letter was mailed on 9/4/19. Today I received an EOB showing that they are beginning to offset my payments. There is a remark code that states " Payment for drugs infused through Durable Medical Equipment (DME) are priced at ASP plus 6%, in accordance with Section 5004 of the 21st Centry Cures Act and TRICARE's requirement at 10 USC Section 1079, to rimburse like Medicare." So I research and see that this rule they are referring to applies to drugs infused through DME. I assume this means infusions, chemo, insulin, etc. We only offer orthotics and prosthetics. I called Tricare again today, and we all know how that goes. She cannot tell me anything other than the same information on their original letter. I explained everything to her that I've stated here and she told me I just need to wait for all the offsets to be completed and then I can request reconsideration. *Also, I did make the spelling errors, that's actually how it is on my EOB.