Harry Nelson5 Ways to Avoid Overpayment Trouble

Harry Nelson was quoted in the December 22 edition of Part B News, a publication of DecisionHealth. The article by Roy Edroso, entitled “5 Ways to Avoid Overpayment Trouble,” offered healthcare providers guidance on avoiding Medicare overpayment issues, such as recoupment actions and potential federal False Claims Act (FCA) liability for non-reporting of payment errors.

The specific tip attributed to Harry was “Refocus your current auditing for compliance,” quoting him for the point that many healthcare providers audit charts principally to ensure that they are “not leaving money on the table” — that is, maximizing revenue, when, in reality, providers “have to be concerned, not just with getting more money, but also with identifying the problems, preventing them going forward and identifying moneys to be returned.”

The other recommendations to avoid Medicare overpayment problems included:

  •  Get a second opinion on whether a claim is an overpayment (e.g. from outside independent consultants);
  • Beware the 60-day window for mandatory reporting and repayment under the Affordable Care Act to avoid potential FCA liability;
  • Look for patterns of denied claims; and
  • Follow through with action on your audit results (i.e. don’t ignore the results once you’ve discovered a payment error.)

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Nelson Hardiman routinely advises providers on Medicare and Medicaid billing and coding compliance matters, both proactively and in response to audits, investigations, and payor recoupment actions or claims.  For more information, contact the firm at info@nelsonhardiman.com.