Find-A-Code Focus Newsletter

Medicare Overpayment Demands: The Financial Timeline and Options

June 15, 2015
The process of Medicare contractors such as Zone Program Integrity Contractors (ZPIC) and Recovery Audit Contractors (RAC), issuing adverse medical review findings and Medicare Administrative Contractors (MAC) subsequently demanding repayment of alleged overpayments can be very daunting for providers. This is particularly true when Medicare contractors employ statistical sampling methodologies which expand overpayment sums to a designated universe of claims beyond just the actual claims reviewed. A few thousand dollars worth of claims suddenly becomes tens or even hundreds of thousands of dollars. In many instances, providers will choose to appeal adverse determinations, ready to defend the good faith provision of services based on the medical needs of its patients. Understanding the financial implications and timeline of an overpayment assessment is hugely important. Should the provider pay the overpayment up front? If the provider can't pay the overpayment sum immediately, how can it work with Medicare to repay the sum in a financially feasible manner? What if the provider doesn't want to repay the overpayment what steps will Medicare take? These questions are best addressed in reverse order.

Continure reading: http://www.billing-coding.com/detail_article.cfm?articleID=5307
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