Incarceration Claim Denials - JF Part B

Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated or in custody under a penal statute or rule at the time items and services were furnished.

Providers Need to Know

Refunds/Adjustments

Providers may receive correspondence identifying claims that were paid during periods when the beneficiary was incarcerated.

Appeals and Disputes

Providers who disagree with the claim repayment amount or refund amount are instructed to file a request for redetermination.

For information on how to file an appeal, refer to the CMS First Level of Appeal: Redetermination by a Medicare Contractor webpage.

Resources

Incarcerated Beneficiary Claim Denial Frequently Asked Questions