What Is Overpayment In Medical Billing? Here's How To Recover
Overpayment in the context of healthcare usually involves physicians, specialists, and/or any other health service providers. However, even if you are at the other end of the line (as a patient), it can still affect you as much as it affects them.
With that said, we cover some of the things you should know about overpayment in medical billing, how to spot it, report it, and even recover from it.
Overpayment in Healthcare
Before you are able to report any overpayment, you should first know what is it before you can even spot it.
According to the Center for Medicaid and Medicare Services, overpayment means receiving an amount that exceeds regulation and statute properly payable amounts. To put it simply, overpayment in the context of healthcare happens when a healthcare service provider receives or reimburses an amount that is over the services that they render.
However, there are chances when medical professionals also end up facing false claims regarding healthcare fraud. And that may end up jeopardizing their career. According to the experts at Rosenblatt Law (where you can read more at https://www.rosenblatlaw.com/health-care-fraud/), in such cases, it would be best for healthcare professionals to seek help from a healthcare fraud attorney. Such professionals can help in dealing with false claims, safeguarding the career of healthcare employees.
For example, you went to a clinic (that accepts Medicare) for a simple check-up. After your check-up, the clinic would then have to reimburse the services that they render to you through Medicare. However, instead of reimbursing and coding it as a simple check-up, the healthcare service provider managed to receive an amount that exceeds the value of a normal check-up. If that happens, then your healthcare service provider might have received an overpayment from the federal government. Overpayment in healthcare usually happens because of:
incorrect or mislabeled coding (like the example above)
improper and insufficient documentation
fraud
administrative errors
and many more
However, there are also some cases where a member like you can receive overpayment as well.
Member Error
Apart from the usual overpayment in medical billing that affects service providers, there are also some instances where a member needs to repay their overpayment as well.
Take this example from the state of Wisconsin’s website. A woman was eligible for a Well Woman Medicaid last February. She had private insurance but her treatments were not covered in time due to the waiting period. With that, Medicaid provided for her services in the meantime. However, whilst she was receiving help from Medicaid, the insurance company finally grant her request and started to cover the treatment as well. The woman did not report the additional aid she received from the private insurance, so now she had to repay the overpayment she received from Medicaid while the private insurance also covers her.
Repayment
Anyone who receives an overpayment from a federal program is required to repay the money back to the government. The overpayment is referred to the Treasury or to a Treasury-designated Debt Collection Center. This department may collect your debt using
demand letters
skip tracing
admin wage garnishment
phone Follow-up
private collection agency
and even through federal salary offset, if you are working in the government
Healthcare providers and suppliers are required to report and return the overpayments within 60 days when the overpayment was identified, 6 years from the lookback period, or the cost report due date.
Recovering from Overpayment
Given that overpayments are required to be repaid, the only way you can recover from it is to actually pay for it.
If your overpayment is more than 25$, then your Medicare Administrative Contractor would send you a demand letter requesting repayment. It is crucial that you respond to this letter and make immediate payment.
But, if you disagree with the letter or the overpayment decision, then you can simply request an appeal. In this case, it would be best to get the help of a professional or even a healthcare fraud attorney. This way, you have a better chance of winning the appeal.
Recovering from overpayment is not that difficult (though it is an easy task as well). But once you know who the right authorities you should reach out to and are aware of the debt collection timeframes, then you can simply settle your balance and recover from it in no time.
Conclusion
Keep in mind that overpayments and other types of healthcare fraud can trickle down into the entire healthcare system, diminishing the quality of care that we receive and ultimately making it harder for people to receive the proper care that they need.
With that said, it is your obligation to repay or even self-report your own overpayment to the authorities.