A medical practitioner in the early years of the 21st century would not have believed his ears if had been told that it’s illegal to keep the excess reimbursements Medicare pays providers once in a while for their services. He/She would have argued, CMS do check and make sure everything is correct before actually paying, right? Not exactly the scenario in today’s world of Patient Protection and Affordable Care Act. There is strictly no such thing as a free lunch; even if it is shoved down your throat, Medicare expects you to regurgitate it within 60 days; else you should be ready with a very good lawyer.
In what scenarios do these excess payments occur you might ask? Errors in medical billing and medical coding due to inadequate training in Medicare procedures has been found to be the most common reason for these over payments in the first place. This could range from a medical coder documenting services in an outpatient setting as a non-facility service, to someone not fully understanding the intricacies of same-day read missions. Or the source could be much before the medical billing and coding processes start, like in situations when the front-office fails to properly verify the eligibility of a patient to receive certain treatments like end-stage renal disease care etc. It could also be someone from the medical equipment team, who instead of taking a faulty device to its OEM or original equipment manufacturer, advises his medical billing team to bill Medicare.
Thus the surest way to avoid an Office of the Inspector General personnel knocking on your clinic’s door is by billing and coding correctly in the first place, by outsourcing it to a dedicated medical billing services company like Billing Paradise (1-888-571-9069 or steve@billingparadise.com). But then if you thought that a medical billing company cannot help you with your already over-billed claims, think again. The newly assembled ACA team at Billing Paradise is well on its way in helping more than 10 clinics avoid a showdown with Medicare. If you are not on a sure footing when it comes to returning Medicare over payments, do contact our ACA Team who can aid you by explaining the following:
1. The rules of the game when it comes to Medicare Over payments.
2. Helping you avoid reading in between the lines by clearly delineating Medicare Overpayment Procedures.
3. Consequences of ignoring the Medicare Ultimatum and what the civil suit may entail.
4. When exactly does the 60-day window start.
5. Best Practices for avoiding over payments in the first place.
Of course apart from the above, our core competency a medical billing company services is sure to help you in plugging these coding slips in the first place, when the same is outsourced to us.
BillingParadise can be reached at 1-888-571-9069 or steve@billingparadise.com.
