When Is a Medicare Payment an “Overpayment?”

You are a Medicare provider of Part A and B services, and a member of your billing staff has just alerted you to a billing software glitch that might have resulted in double billing of certain services to the Medicare program. Having been in the business for a while, you are aware that Medicare overpayments must be returned to the program, but your angst at having learned of this possibly expensive and dangerous computer glitch has robbed your brain of all of the details of regulatory compliance in the area of Medicare overpayments.

You pull up some online information from the Medicare website and realize that the process of compliance is complicated and dependent on interpretations of the specific facts of your situation. You understand you have a sixty (60) day window to report and repay the amount, but you are uncertain when the clock starts to run on that time limit. At this point in your understanding of the problem, you are not even sure that there has been an overpayment, and if there is, how much is at stake and for how long the problem has existed, not to mention how far back in time you need to go to establish and repay the amount. So many questions, too few answers!!

This is where experienced counsel steps in and guides the provider through the legal thicket into a place of resolution and repose. A logical and efficient sequence is set in motion to determine first if there has indeed been an overpayment that must be reported and refunded. And once the fact of the overpayment is established, a work plan is developed to ensure that the overbilling is stopped going forward, and quantified accurately going backward in time six (6) years, or however long the glitch has been causing overpayments if the time period is shorter than six (6) years. Skilled counsel might also recommend coordinating with the Medicare program and HHS Office of Inspector General in cases in which a formal self-reporting might be in order, or an extension in the permitted time frame needed to complete the internal investigation of the overpayment facts and amounts.

If you suspect a Medicare overpayment, don’t panic, don’t overreact, but do contact Flanagan & Testoni to guide you through the Medicare overpayment determination and repayment process.

Categories: Medicare

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