ED Coding & Reimbursement Alert - 2016 Issue 18
Billing Compliance: Why the 60-Day Overpayment Rule is a Qui Tam Waiting to Happen
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Article Overview
This article explains the Medicare 60-day overpayment rule and the broader compliance concerns that can arise when an organization identifies a potential overpayment. It is aimed at healthcare billing and compliance professionals who need a general understanding of refund timing, retrospective review expectations, and the federal enforcement risks that may follow delays or unresolved billing issues.
Why This Topic Matters
Organizations that bill federal health programs need to recognize and respond to overpayments quickly, because delays can create regulatory and legal exposure beyond the original billing issue. The article is relevant to compliance teams, billing leaders, and revenue cycle staff responsible for identifying, reviewing, and correcting payment discrepancies.
What You Will Learn
- How the 60-day overpayment rule fits into Medicare compliance
- Why retrospective review and reasonable diligence are relevant to overpayment identification
- What general federal enforcement risks may arise when overpayments are not addressed promptly
- How documentation problems and coding issues can relate to overpayment concerns
Who Should Read This
- Medical billing professionals
- Compliance officers
- Revenue cycle managers
- Healthcare attorneys
- Practice administrators
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