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OON Provider receives Medicare and Patient payment, what now?

January 17, 2017

Question:

Hi Jennifer, 

I withdrew from Medicare 3 + years ago.  Recently, I had a patient ask us for his statement so he could submit it to his Aetna Medicare. He submitted it, he got reimbursed but 2 problems:  a) aetna electronically reimbursed into my checking account as they have done in the past and b) this patient already paid me for these services that he just submitted.

Please shed some light on this.  Thank you, I appreciate your time and expertise.

Dr. Z

Answer:

Without reviewing the paper trail, including your financial policy with your patient, I cannot offer a definitive opinion. However, if the facts you convey are as you say, and the documentation substantiates, you may want to consider refunding to Medicare - if in fact this was an Aetna Medicare plan, as you say.  If this was Aetna out of network reimbursement as private pay, that would make more sense to me. Certainly you cannot keep a double payment.  

This is an example of where we may need to talk offline if you want help papering and an accurate assessment. Navigating payor contracts, protocols, etc. can easily turn into a quagmire.  



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