tci Medicare Compliance & Reimbursement - 2023 Issue Q2

Reader Questions: Know the Timeline and Circumstance for Medicare Overpayments

Question: Who is responsible for identifying and correcting overpayment in any Centers for Medicare & Medicaid Services (CMS) reimbursement? Is there a lookback period or is any claim ever paid fair game? AAPC Forum Participant Answer: According to CMS and the Medicare Learning Network (MLN), overpayments may be identified by CMS; a Medicare Administrative Contractor (MAC); or a provider, via self-identification. CMS leans on providers to be keeping track of payments.“Through reasonable diligence, a provider can identify any overpayment and calculate the amount,” CMS warns in an MLN fact sheet. Section 1128J(d) of the Social Security...

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