Every system, no matter how well-intentioned or structured, has its inherent flaws, and Medicare is no exception. Over the years, the complexities and vulnerabilities within the Medicare system have led to instances of fraud, waste, and abuse, prompting the government to increase audits and crackdowns on Medicare payments. While these measures help to ensure accountability and protect public funds, they can inadvertently place a burden on private practices. These practices often operate with limited administrative resources, and the increased scrutiny can lead to heightened operational costs and administrative challenges. This can divert attention from patient care and strain the financial stability of smaller practices, potentially impacting their ability to provide quality healthcare services.
There are steps practices can take to reduce the risk of falling victim to the government’s increased enforcement efforts for Medicare overpayments. Three examples include the following.
#1: Improve billing practices
The best way to avoid an allegation of an overpayment is to make sure your group is following proper protocol in its billing practices. Adoption of standardized procedures can help to better ensure compliance and accuracy in billing. Once your group agrees to a standardized plan, make sure to have regular training for staff. It is also important to revisit and update the plan on a regular basis.
#2: Use advanced analytics
Private practices can make use of advanced data analytics to proactively identify billing errors that could result in allegations of an overpayment. This internal audit can provide valuable information, allowing the practice to find and fix potential issues before they become a bigger problem.
#3: Stay up to date on Medicare policies
A failure to stay up to date with the latest expectations can trigger an investigation. You can mitigate the risk by:
- Read official updates. Review official Medicare newsletters and updates, which provide timely information on policy changes and new regulations.
- Attend workshops. Whether a workshop, webinars, or training sessions, these gatherings provide opportunities to help stay up to date on changes to Medicare that could impact your practice.
Innovative technologies and strategies can help your practice to use its administrative resources wisely to reduce the risk of allegations of a Medicare overpayment. Those who find themselves the subject of an investigation or overpayment demand are wise to take action to protect their interests. An attorney experienced in this area of law can review your situation and provide guidance to better ensure a more favorable outcome.
Attorney John Rivas is responsible for this communication.
