BACKGROUND

A client received a letter from Medicare that they had paid the practice incorrectly for three years and therefore would be recouping $60,000 back. This triggered a great amount of confusion regarding the reason for recoupment, which the letter did not clearly specify. Was this a billing error? Could it have been avoided? How do we know when the amount is fully reconciled?

WHAT WE DID

We stepped in to work with Medicare to analyze the reasons for recoupment. It was system error in their software. While the electronic remittances were sent to Dr. Y, the money was sent to our client Dr. X. We helped the doctor reconcile the excess payments by matching them with paid EOBs, helping understand the reconciliation process.

CONCLUSION

So can Medicare pay you wrongly? Yes, they can. They can also have systemic errors like we faced. The best way to counter such issues is to analyze EOBs periodically against actual payments received.