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3 questions about an overpayment demand letters for birth tissue injections

Physicians throughout the country are finding themselves the recipients of a mailing from the government claiming that they must pay back Medicare payouts related to birth tissue injections.

Part of the reason the demand is so frustrating is that it appears the Centers for Medicare and Medicaid Services (CMS) gave this treatment its very own billing code and at $2,000 per injection, the payouts were high. So high that some practices are voicing concern that the government’s attempt to recoup these funds could lead to serious financial trouble and even result in closure.

What are these letters?

These demand letters attempt to claw back payments apply to amniotic, placental, and umbilical cord injectables.

What is a claw back?

This term refers to the government’s ability to agree to a healthcare provider’s request for payment of a claim, pay the claim, change their mind, and then demand the healthcare provider return that payment.

A failure to return the payment can result in additional fines and penalties as well as exclusion from coverage.

What can I do about it?

There are options. In this instance, the government is making an aggressive argument that the provision of a Q code for billing purposes does not mean that the treatment is automatically covered by Medicare and points out that these codes are temporary. It also claims to have provided previous guidance that stated these types of procedures did not qualify for coverage.

Physicians who receive a demand letter can fight back. It is possible to build a defense against overpayment claims by Medicare for billing related to Fluid Flow amniotic treatment. An attorney can review your situation and discuss which options will best protect your interests.

Attorney John Rivas is responsible for this communication