BC Advantage - 2015 Issue 5

Medicare Overpayment Demands: The Financial Timeline and Options

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...

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