An overpayment recovery request from Medicare or a private carrier essentially means the payer is stating that they want their money back. They already sent your group payment for a claim, but now they have decided the payment was either too much or unwarranted. It is important to take this request seriously. Do not put off dealing with and hope it will go away. There are often time constraints that limit when you can appeal or challenge the request. If you do not act promptly, you could miss your chance.
How does the process work?
The process to appeal or fight back against an overpayment recovery request is generally governed by the contractual relationship between your group and the insurance company. The American Medical Association recommends reviewing this contract, as it may contain provisions that will reduce your group’s administrative burden in these situations.
In some cases, state law may also apply. The AMA further notes that almost half the states in our country have statutes that provide physicians with additional protections in these situations.
How can I protect my rights?
Physicians and group practices can take further steps to protect their rights by hiring legal counsel. An attorney experienced in this niche area of healthcare law can review the overpayment recovery request, the contracts you have with insurance providers as well as applicable state law and regulations and discuss your options. This can help to better ensure you understand what is happening while also protecting your rights throughout the process.