Health Law | Medicare Post Payment Review | Recoupment
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Pennsylvania Health Law Firm
The Martin Law Firm, located in Blue Bell, PA, regularly handles Medicare post payment reviews on behalf of its health care provider and supplier clients including MDs, DOs, DCs, PTs, ASCs, hospitals and health systems. Although based in Pennsylvania, we assist health care provider clients throughout the U.S.
Medicare Post Payment Review
The Medicare Integrity Program authorizes the Centers for Medicare and Medicaid Services (CMS) to hire Medicare contractors and Recovery Audit Contractors to perform post payment reviews of health care providers' medical records to ensure compliance with coding, coverage (i.e., medical necessity services) and other guidelines. When suspected non-compliance is identified, CMS can perform a more thorough review of claims after payment has been made to the provider. This is referred to as a "Medicare Post Payment Review" or "Medicare Audit."
Medicare Overpayments and Recoupment
Medicare post payment reviews are extremely challenging for health care providers because an adverse determination often leads to a calculation of an overpayment. This overpayment is based on a sample of claims that are denied, and then the sampling can be extrapolated to the universe of claims submitted by the provider. The extrapolation method can often generate substantial overpayment determinations and efforts to collect these overpayments from the provider through voluntary payments or recoupment. Recoupment is the process that Medicare utilizes for recovery of outstanding debt by reducing present or future Medicare payments and applying the amount withheld to the indebtedness.
Contact an Experienced Pennsylvania Medicare Attorney
Handling a Medicare post payment review takes experience and knowledge. The Medicare appeals process can be quite challenging for an inexperienced health care provider. Generally, the Medicare appeals process has five stages, and navigating through each stage takes skill and a thorough understanding of federal law, guidelines and regulations. The Martin Law Firm partners with certified coding specialists and other professionals to provide quality, efficient and diligent Medicare audit defense for its health care clients.
Contact attorney Jason B. Martin at the Martin Law Firm for a free case evaluation.
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