When the Centers for Medicare and Medicaid Services (CMS) identifies an overpayment, it views the overpayment as a debt owed by the practice or health care organization to the federal government. These alleged overpayments can happen for any number of reasons, including incorrect coding, processing or administrative errors and a lack of documentation to support the billing.
Step 1: Review the overpayment demand
Whatever led to the overpayment, the notification is likely frustrating and concerning. Those who receive this demand have options, but it is important to note that you are also on a ticking clock. It is important to take prompt action once you receive an overpayment demand. The letter should include a reason for the overpayment along with a brief discussion of your rights.
Review the notification carefully and look for deadlines. The feds take these deadlines seriously and a failure to act within the set time limit can make it difficult to challenge the demand.
Step 2: Act to preserve your interests
After reading over the demand, the following steps can help to better ensure your rights are preserved when trying to deal with this demand:
- Delegate. You do not have to go through this process alone and let’s be honest, dealing with anything involving the federal government is a tedious process. You can delegate this matter to experienced counsel so you can focus on your medical practice or healthcare organization.
- Review the timeline. It is helpful to have a basic understanding of the timeline associated with these claims. In general, those who receive a demand have 30 days before the feds will start recouping the alleged overpayment and applying interest accrual on the overpayment.
- Determine the best course of action. Those who receive the demand can repay the alleged overpayment or challenge the claim. This can either be done by appealing the overpayment and requesting a redetermination.
The best course of action will depend on the details of the situation. An attorney experienced in this area of the law can review your case and discuss the pros and cons of each option so you can better ensure you choose the option that is right for your group.
Attorney John Rivas is responsible for this communication