Keep track of LCA overpayments, underpayments

Why This Topic Matters

Retroactive LCA policy changes can create confusing balances, unexpected offsets, and possible interest issues. Understanding the scope of affected claims helps practices verify payer activity and recover amounts that may be owed.

Article Sections

1. LCA payment problems in urology

   Introduces the payment issues that can arise when carriers apply least costly alternative policies to urology drug claims. It outlines the general impact on practices and why retroactive adjustments can be difficult to manage.

2. Examples of carrier and Medicare adjustments

   Describes reported experiences from practices dealing with retroactive underpayments, overpayments, offsets, and interest. It highlights the kinds of payer activity that may need to be reconciled.

3. Track payments for prostate cancer drug and injection codes

   Presents a general workflow for identifying affected claims, reviewing account-level payment activity, calculating differences, and communicating with the carrier. The section emphasizes documentation and claim tracking.