Make sure you're billing the right insurer, HCFA official warns

Why This Topic Matters

Improperly billing Medicare as the primary payer can trigger recoupment activity and create financial and compliance risk for practices. The article highlights why routine insurance verification and documentation matter in Medicare claims processing.

Article Sections

1. Tracking down overpayments

   This section describes HCFA’s increased coordination-of-benefits enforcement and the contractors and data-matching efforts used to identify potentially problematic claims. It also discusses how claims are selected for review at a general level.

2. How to fix the problem

   This section discusses practice-level insurance verification processes and patient questionnaire topics meant to help identify whether Medicare is the correct payer. It also touches on documentation and office procedures.

3. Why go after practices?

   This section explains why providers may be the focus of MSP recovery efforts and summarizes the broader policy context around insurer cooperation and Medicare’s secondary-payer status.