OMIG Issues 2nd Demand Bill Notice on TPL Cases 

Situation Report | November 2, 2020

The state Office of the Medicaid Inspector General (OMIG) has sent Certified Home Health Agencies (CHHAs) a second notification letter reminding providers of their obligation to submit demand bills to Medicare appealing cases identified for the first half of federal fiscal year (FFY) 2020. 

This notice follows an earlier one (mailed on August 31, 2020) that most Medicare-certified home care providers should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS). 

If you have already demand billed all your cases, as requested in the August 31 letter, please make sure you provide copies of the following documents to OMIG’s TPL contractor (UMMS) within 10 business days: 

  • A copy of the original claim submitted to the Medicare Administrative Contractor (MAC) for each 60-day episode billed.
  • A copy of the final claim remittance advice sent to you from the MAC.
  • A copy of each medical record your agency submitted to the MAC upon the Additional Document Request (ADR) request.

OMIG’s letter also says CHHAs must act immediately if they have not yet demand billed for the cases previously identified and provide the requested documentation within 10 business days. (Under federal regulations, Medicare claims for services must be filed within 12 months after the date of service.) For those who do not act, OMIG says it will conduct an audit to recover the medical assistance payment, subject to interest accrual. 

For specific questions about the letters, contact UMMS’s Erin Devaney at (866) 626-7594.