Medicare PDPs must pay back-claims, CMS says

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Medicare Part D plans cannot refuse reimbursement for certain claims covering periods of retroactive enrollment, according to the Centers for Medicare & Medicaid Services.

Some plans have been wrongly denying claims for coverage in retroactive enrollment periods because the claims were not submitted before the March 31, 2007, deadline, according to a recent memo from Cynthia G. Tudor, director of CMS's Center for Beneficiary Choices Medicare Drug Benefit Group.

Beneficiaries who made payment during a retroactive eligible period are entitled to reimbursement, CMS said. A recent study from the Government Accountability Office found that dual-eligible beneficiaries did not pursue retroactive Medicare Part D payments last year because the government did not notify them of this right until March of this year. Many dual eligibles reside in nursing homes.

The CMS memo is available on the American Society of Consultant Pharmacists Web site at http://www.ascp.com/medicarerx/upload/CMSRetroactiveEnrollments052507.pdf.