The Retroactive Medicare Recovery Project (RMRP) is an ongoing MassHealth project. Through the RMRP, MassHealth notifies providers of retroactive Medicare entitlement for dually eligible (Medicare/MassHealth) members for paid MassHealth claims when the following criteria is met:
- MassHealth was the primary claims payor at the time when services were rendered;
- Medicare coverage is identified retroactively after the date MassHealth paid the claim, but no more than 36 months after such claim’s date of service; and
- the service rendered is a Medicare-covered service (RMRP-Eligible Claims).
Over the last several years, MassHealth implemented a system of demand billing to recoup RMRP-Eligible Claims, directing providers to submit any such RMRP-Eligible Claim for Medicare-covered services to Medicare and then recouping such claim payment systematically through MMIS claim void transactions after Medicare reimbursed the provider.
The Massachusetts Supreme Judicial Court’s recent decision in Atlanticare Medical Ctr. v. Div. of Med. Assistance, 485 Mass. 233 (2020) (Atlanticare), however, permits MassHealth to streamline this process for any RMRP-Eligible Claim with a date of service on or after July 22, 2020, allowing MassHealth to void any such claim before the provider bills Medicare for such claim. Pursuant to this authority, MassHealth may void such an RMRP-Eligible Claim and require the provider to bill Medicare before resubmitting a new claim to MassHealth for any remaining patient responsibility amount after Medicare has adjudicated the claim.
Careful compliance will help you prevent problems with dually eligible members before they start. If your organization is having trouble with this or any other billing matter, please contact us today!