tci General Surgery Coding Alert - 2021 Issue Q2

Reader Questions: Respond to MAC Overpayment Claim

Question: We received a “demand letter” from our MAC claiming that we were overpaid. We think this is in error, based on our record review. Can we appeal this? Iowa Subscriber Answer: With Medicare overpayments, you have two choices: You can send your MAC a rebuttal or you can appeal the decision, initiating the traditional Part B appeals process. Appealing an overpayment is similar to appealing a denied claim. You’ll need to collect and submit documentation to your MAC proving medical necessity. The standard five levels of Medicare appeals apply and include the following: Level 1: Redetermination...

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