CMS Pub. 100-16, ch. mc86c18b, § 140

Several entities may have jurisdiction over the processing and payment of Part B bills for

an HCPP's members. This could result in duplicate payments to either the physician,

supplier, or to the enrollee. It is incumbent that HCPPs establish a system to preclude or

detect duplicate payments.

HCPPs are required to process all nonprovider Part B bills, with some exceptions. These

exceptions, as noted below, are processed by the carrier:

• Claims for services by an independent physical therapist;

• Claims for outpatient blood transfusions;

• Claims from physicians for dialysis and related services provided through and

approved dialysis facility; and

• Hospice care by Medicare participating hospices, except:

(a) Services of the enrollee's attending physician if the physician is an

employee or contractor of the organization and is not employed by or

under contract to the member's hospice; and

(b) Services not related to the treatment of, or a condition related to, the

terminal condition.

Duplicate payment detection is the responsibility of the HCPP, not the carrier. The

HCPP should perform several duplicate check functions after it receives paid claim

information. If the HCPP has not previously paid the claim, a copy of the claims

information is filed in the beneficiary's history file. If the duplicate payment check

reveals that the HCPP has already paid for the services:

• Contact the physician/supplier or enrollee to retrieve the overpayment;

• Record any collections as credits on the cost report;

• Notify CMS of unresolved overpayment situations; and

• Do not return payment to the carrier.

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