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Overpaid? Send it back, and quickly – Ophthalmology Management

Recent actions by payers and law enforcement have changed the landscape regarding refunding overpayments — and not in ways that favor practices. Importantly, two recent precedents make it clear that you no longer can “investigate whether the overpayment is real” before determining that the 60-day window is implicated; it begins immediately. Here is an update on what you need to know.

This article addresses the following subjects:

  • What is an overpayment?
  • What happens when an overpayment is found?
  • How should we handle refunds?
  • What about related copayments and deductibles?
  • Is refunding an overpayment sufficient to address the problem?
  • Does refunding an overpayment lead to an audit?
  • Do we need an attorney to make a refund of an overpayment?
  • Should we report overpayments to the Office of Inspector General?

This article was published in Ophthalmology Management’s Coding & Reimbursement column, which is written by Corcoran’s Executive Vice-President, Suzanne Corcoran, COE. To view the entire article in Ophthalmology Management, click on the link below:

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