Responding to Postpayment Review – Review of Ophthalmology

New legislation and an assortment of programs can complicate Medicare payments. Proper navigation may avoid audits.

This article answers the following questions:

  • Has recent legislation led to additional scrutiny for payments made to health-care providers from federally funded programs?
  • How can I identify the value of improper Medicare and Medicaid fee-for-service payments?
  • What is a ‘CERT’ audit and what does it entail?
  • What is the process for responding to a CERT record request?
  • What is the Recovery Audit Contractor program?
  • How do I find out who my RAC is?
  • Limits exist for record review requests based on the size of the physician practice. In a 45-day period, they may request no more than:
  • How do we respond to a RAC demand letter?
  • Will the RACs recoup my overpayment from my future Medicare checks?
  • Have there been any changes to the Medicare claims appeals process?
  • Where can I learn more about the various levels of appeal?
  • Is there a way to mitigate potential overpayments in my office?
  • Are any of these compliance programs mandatory?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:

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