If there was ever a better time to perform surgery on your neurosurgery coding, it’s now. Why? Your practice is at increased risk for overpayments and high paid claim error rates. A cerebral analysis of your neurosurgery billing will minimize your risk. If you haven’t felt the effects of increased federal government scrutiny of your neurosurgery coding, you very well might—and soon. CMS has increased medical practice audits across the board resulting from overpayments.
The right healthcare revenue cycle management team will understand your unique neurosurgery billing nuances as the government continues to cut the Medicare FFS improper payment rate and reduce overall payment errors by billions of dollars.
When it comes to overpayments, there are many questions that arise and answers need a legal perspective. Polsinelli law firm’s attorneys Jeffrey Fitzgerald, Esq. and Asher Funk, Esq. provide answers to some of the more commonly asked questions applicable to all medical specialties.
Is there a duty to repay overpayments to Medicare?
Yes. An overpayment is defined as any funds that a “person” (enrolled Medicare provider or supplier) receives or retains under Title XVIII or XIX to which the person, after applicable reconciliation, is not entitled under such title.
Any overpayment retained after the deadline for reporting and returning is an “obligation” (as defined by the False Claims Act or FCA). FCA liability exists when knowingly concealing or knowingly and improperly avoiding or decreasing an obligation to pay or transmit money or property to the government (31 U.S.C. 3729(a)(1)(G).
Who has to make the repayment?
The entity that receives the Medicare/Medicaid payment has the duty to repay.
According to the Patient Protection and Affordable Care Act (“PPACA”) Section 6402
- If a person has received an overpayment, that person shall
- Report and return the overpayment
- Notify the Secretary, … in writing of the reason for the overpayment
- The overpayment must be reported and returned by the later of
- The date which is 60 days after the date on which the overpayment was identified; or
- The date any corresponding cost report is due, if applicable
If there is a potential overpayment, how far back should we audit?
When did the problem start? Factually speaking, is it based on a change in a billing system or software, or on HR changes or employee conduct? Can you go back and pinpoint a time frame based on these factual changes? If not, then look at the legal limits.
If there is no factual limit, look at the legal limits:
- Medicare claims reopening: 4 years (42 C.F.R. 405.980(b), 42 U.S.C. 1395ff(b)(1)(G))
- Revisions to overpayment “recovery” period in the American Taxpayer Relief Act of 2012 do not require longer look-back period (extended recovery period from three years to six years (42 U.S.C. 1395gg(b))
- False Claims Act: 6 years
NOTE OF DISCLAIMER: This blog is for general informational use only. Please consult with your legal counsel and/or the experts at revMD.com for advice specific to your neurosurgery practice.
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