Nursing Home Case, Medicare Final Demand

Posted by Matthew Garretson

Question:
Any thoughts on what should be done, if anything, when a final demand is issued that does not include charges that were originally listed on the conditional payment letter? Some of the missing charges were initially disputed but not removed on the 2nd conditional payment letter, and some of the charges were never disputed.

-Michigan Attorney

Answer:
Based upon our experience, it is Medicare’s procedure that when they receive a request for Final Demand they do a final canvassing and review of all claims. It is not uncommon for Medicare to include additional related claims or remove claims they have determined to be unrelated, thus changing the amount of the original conditional payment summary. It is only have after this final process is completed that the Final Demand issued.