Health providers must always ensure that their policies and procedures are in keeping with Medicare laws, especially those relating to billing requirements. If you are a health provider, you ought to understand how your practice can avoid Medicare overpayment issues that may require investigation.
Medicare billing records are investigated by the Medicare Recovery Audit Contractors (RAC’s). Any incidences of improper payments found by the RACs are reported to the Center for Medicare and Medicaid services (CMS).
Payments made by Medicare in excess of the amounts properly payable under the Medicare statutes, are considered overpayments. Overpayments often occur when claims are submitted that do not meet the coding requirements, or the medical necessity criteria of the CMS.
How to avoid Medicare Overpayment
- Employ a Compliance Officer: Having a compliance officer on staff to oversee your Compliance Program can help you avoid overpayment issues. A compliance officer can oversee the billing system, ensuring that it is accurate and up-to-date.
- Report Overpayment: If a payment error is discovered during a self-audit, the violation should be reported and paid back within the 60-day window, as per the Affordable Care Act.
- Double check Claims: Enlist the services of an attorney to verify that services are being correctly billed.
Health providers should take the necessary steps to avoid billing errors, because these can be very costly. In the event of an overpayment the provider may have to return the funds to Medicare, and also pay any accompanying penalties.
If you would like to find out more about how your practice can avoid Medicare overpayment, contact Nelson Hardiman, LLP, Los Angeles, CA. We can provide help with these and other Medicare compliance issues. Give us a call at 310-203-2800 to set up a consultation.