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  • CAAP Recoupment on Medicare Claims

    Ophthalmic practices who received a COVID Accelerated/Advance Payments (CAAP) from CMS will start to see a new physician adjustment amount on their remittance advice. Repayments automatically begin one year from the date the advance payment was made. The payment offset will be applied to all affiliated physicians sharing the same tax ID number, so be sure you track each physician of the practice. The recoupment will be 25% for the first eleven months of the repayment followed by an increase to 50% for another six months. After the six months end, a letter for any remaining balance of the CAAP will be issued, where practices will have 30 days from the date of the letter to repay the balance in full.  

    If you choose to make larger payments, contact your Medicare Administrative Contractor (MAC) directly for their specific forms. Practices who meet hardship criteria, specified in 42 C.F.R. 401.607(c)(2), may be able to extend their repayment. Each practice should reach out to their MAC for details on requesting an extended repayment schedule, as many have their own forms and requirements.  

    How can you tell the recoupment is for CAAP? You will see the following remark codes:  

    PLB Reason Code: WO CVDAR 

    Each physician or practice who received the CAAP should be in contact with the staff person tasked with overseeing this payment and re-payment process. The delegated person is whom Medicare provides information directly that impacts your practice. Medicare indicated they will not provide you with the details of the practice delegated person. 

    For additional information, Medicare has provided a FAQ, or reach out directly to your MAC.