tci Part B Insider - 2005 Issue 1

Reimbursement: Carriers Can't Punish You For Self-Disclosing Problems - But There's A Catch

Don't go straight to the carriers if the problem looks seriousThe Medicare Modernization Act contains one welcome provision that prevents your carrier from putting you on prepayment review if you come forward voluntarily to disclose a billing problem. Or does it?Now the Centers for Medicare & Medicaid Services has carved out an exception to that rule which the carriers could drive an 18-wheeler through. If you self-disclose an improper business practice, "and the contractor determines that there is a sustained or high level of payment error," then the carrier can go ahead and put you on prepayment...

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