tci Medicare Compliance & Reimbursement - 2021 Issue Q1

Reader Question: Turnaround Time Matters for Medicare Overpayment Rebuttals

Question: Our practice just received a “demand letter” from our Medicare Administrative Contractor (MAC) insisting that we were overpaid. According to a thorough review of our records, we feel that the MAC is mistaken. Do we have any recourse? Illinois Subscriber Answer: Yes, you do. With Medicare overpayments, you have two choices. You can send your MAC a rebuttal, or you can appeal the decision, initiating the traditional Part B appeals process. Appealing an overpayment is similar to appealing a denied claim. You’ll need to collect and submit documentation to your MAC proving medical necessity. The standard...

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