tci General Surgery Coding Alert - 2023 Issue Q3

Reader Questions: Follow Rules for Medicare Overpayment

Question: Who is responsible for identifying and correcting overpayment in any Medicare reimbursement? Is there a lookback period or is any claim ever paid fair game? AAPC Forum Participant Answer: According to the Centers for Medicare & Medicaid Services (CMS), the overpayments may be identified by CMS; a Medicare Administrative Contractor (MAC); or a provider, via self-identification. CMS leans on providers to keep track of payments. “Through reasonable diligence, a provider can identify any overpayment and calculate the amount,” CMS states in a Medicare Learning Network (MLN) fact sheet. Section 1128J(d) of the Social Security Act requires...

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