Washington, DC (PRWEB) July 03, 2013
A Medicare audit of a Kansas physician group is raising eyebrows because the audit findings were employed by secondary payers to recoup their share of the purported overpayment, Atlantic Info Servicess Report on Medicare Compliance has learned. Published in the July 1 issue of the weekly newsletter, the physician groups knowledge is a reminder that the use of extrapolation is spreading.

Their business office manager has a two-foot-higher stack of secondary payer requests for repayment primarily based on the MAC [Medicare administrative contractor] audit, says Richelle Beckman, an lawyer with the Forbes Law Group in Overland Park, Kan., which represents the physician group. As soon as the MAC completed the audit and identified overpayments, all the secondary payers requested their share before the physician practice even received the MACs demand letter or had a chance to appeal the denied claims, she says. If and when the physician practice wins its Medicare appeals, it will have to battle each and every secondary payer separately utilizing whatever appeals process it has established.

Ernie de los Santos, CEO of the Appeal Academy in Los Angeles, thinks this is a cautionary tale for other providers. In this case, you dont know [the provider] is wrong however. You havent gone by means of due process and they are entitled to due process, he notes. It seems unfair to providers.

Check out http://aishealth.com/archive/rmc070113-01 to study the article in its entirety.

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