Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other

Regards,

Tom Kane, PT
MediGraph Software

CMS Defines Overpayment Process
9/15/2011 10:04:00 PM

In July 2011,  CMS issued a fact sheet to  define the collection process as related to overpayments. At the end of this post a link to CMS that provides the info is available.  Therapists who have not yet gone through this process may find this post and the link useful.

A Medicare overpayment is a payment received in excess of amounts due and payable under Medicare statute and regulations. When an overpayment has been discovered the overpayment is now a debt owed to the federal government.   Federal law requires that CMS recover all identified overpayments.

The main reasons for overpayments include:

  • Payment for excluded or medically unnecessary services (the greatest PT threat)
  • Duplicate submission of the same service or claim
  • Payment to the incorrect payee;
  • A pattern of billing for excessive or non-covered services.

Consider this sad fact; an overpayment of only $10 or more launches the recovery process.  A "Demand letter" is sent to the therapist requesting payment. Interest begins to accrue from the day the letter is sent.  If the overpayment is not received within 31 days (calender days) from the date of the letter a second demand letter will be sent with the expectation that payment will be received with 40 days of the first demand letter.

If payment isn't received, no collection call will be forthcoming.  Instead, the recoupment process is put in motion.  Recoupment  means that the overpayment will be recovered from current payments due or from future claims submitted to Medicare.  If the debt remains unpaid and you have not filed an appeal the therapist will receive  an "Intent to Refer" letter within 120 days. The "Intent to Refer" letter means that the feds can refer the therapist to the Department of Treasury for offset or collection.

In the link to CMS,  the details of the rebuttals and appeals, including a redetermination request for reconsideration is presented when you do not agree with the overpayment declaration.

To view the CMS fact sheet visit:  https://www.cms.gov/MLNProducts/downloads/OverpaymentBrochure508-09.pdf

Regards,

Tom Kane, PT