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Many claims analysts feel that chasing down overpayments feels like plugging leaks in a sinking boat. By using real-time analytics and data validation tools, payers can catch errors before claims are paid, reducing overpayments, denials, and administrative friction. This is why payers are now shifting toward pre-pay accuracy.
What is Medicare Overpayment? An overpayment is a payment made to a provider exceeding amounts due and payable according to existing laws and regulations. Identified overpayments are debts owed to the federal government. Laws and regulations require CMS recover overpayments. Medicare Overpayment Collection Process.
CMS requires chart reviews to catch overpayments. Reasons for chart reviews include: Finding clinical interventions that weren’t correctly billed, or perhaps weren’t billed at all. Figure 1: Dashboard showing a breakdown by year Chart reviews are independent examinations of patients’ clinical records.
In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first. Medisys Data Solutions is a leading medicalbilling company providing complete medicalbilling and coding services.
It’s estimated that up to 80 percent of medicalbills contain errors amounting to billions of dollars that are lost annually to payers. This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected. Providers navigate abrasive recoveries and revenue instability.
Common Issues Impacting SNF Billing Compliance Improper Payments: Errors in coding or documentation can lead to overpayments or denials. Medically Unreasonable Care: Billing for services not deemed necessary by Medicare standards results in claim rejections. Claims must reflect the terms of insurance contracts accurately.
Through a combination of data analysis, investigations, medical reviews, and site visits, UPICs scrutinize healthcare providers and suppliers to ensure compliance with billing rules and the provision of medically necessary services.
We recommend formal training in denials and appeals management and encourage medicalbilling companies and practice managers gain better insight into accounts receivable (A/R) management through online training and certification. This information is not all-inclusive and is for educational purposes only.
The differences in CPT (Current Procedural Terminology) codes is one of the most important aspects of medicalbilling and coding for healthcare providers. Use medical decision-making as the guiding factor, not just the duration of the visit. Tip : Always match the complexity of the case with the appropriate CPT code.
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