DHCS has posted a notice and all impacted providers should be receiving a letter announcing the initiation of the claw back of the 10% provider rate cut for DME. Here is a link to a copy of the announcement
http://files.medi-cal.ca.gov/pubsdoco/epc/epc.asp
This letter will only be sent to the provider "pay to address" on file so you may want to check that address. The claw back covers DME payment for the period between June 1, 2011 through October 23, 2013. The adjustments will appear on the impacted provider RAD forms beginning about August 24, 2017. It will not include a total of the dollars to be recouped or a complete listing of all impacted claims. Each RAD will only include those specific impacted claims and the amounts being taken back.
CAMPS met with representatives of DHCS and Conduent, formerly Xerox, about the claw back and raised several concerns. There currently is no limit on how much of the total check write that could be withheld, i.e. if the provider owes $40,000 and the current check write is $10,000 the provider could receive a $0 check write. There will be a process for a provider to claim hardship and space out the recoupment payments. In addition, since there are so many claims they will only be run in batches and a provider's claims could be in several different batches showing up in different check writes. A provider can query the system by ranges of dates of service and determine how many claims and the dollars involved.
We are obtaining additional information on how providers can claim the hardship exemption and will provide details in a subsequent email. The claw back will only be taken from fee for service claims processed by Conduent.
