G2 News-At-A-Glance: Medicare Coverage of Incarcerated Beneficiaries

A new fact sheet designed to educate providers and suppliers on Medicare’s policy generally not to pay for medical items or services furnished to incarcerated beneficiaries became available in October on the Centers for Medicare and Medicaid Services Web site in the Medicare Learning Network section. The fact sheet is only concerned with billing under Medicare fee-for-service policies and covers the following information: policy background, the definition of individuals who are in custody (or incarcerated) under a penal statute or rule, how to determine whether a beneficiary is in custody under a penal statute or rule, Medicare claims processing for items and services for incarcerated beneficiaries, exception to Medicare policy, and Informational Unsolicited Response (IUR). The IUR process is designed to mitigate a vulnerability in the Medicare system when a beneficiary has been incarcerated but Social Security Administration (SSA) and Medicare records have not yet been updated. In this period, claims may be paid erroneously. The IUR process is initiated when SSA files are updated and overpayments are discovered. The process recoups the overpayments.