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if your watching this video you've probably received a medical
notice of over payment unfortunately they're becoming more and more common
for new york and new Jersey providers but there are remedies
and providers have rights there's just a few important things that
you need to know most important and critical at this point is for you act fast most cases you
have less than 30 days
to address that notice of over payment and descend to medicare something called
an appeal for redetermination
if you want to make sure that medicare doesn't take those alleged overpaid
funds out of your future checks while you're trying to resolve this situation
once you get your appeal paper work in order and you're sure that
the funds are not going to be taken out of future checks during the appeal process
you going to have to start reviewing the substance of the claim so what does that
mean you have to look at the auditors notes and the records and you have to find out why
were you audited
what was the auditors determination is it
an issue of medical necessity in a lot of cases medicare does something called
a statistical analysis and they do a statistical
extrapolation of the medical records that they had and make their
overpayment decision based on that statistical extrapolation
so if that's what you're facing you may have to act in kind
meaning you may have hire a statistician of your own to challenge the statistical analysis and
see
if there was any errors or flaws with it, if you're facing an issue of medical necessity
you may need to hire a registered nurse or another medical
expert to review the medical record and determine if there's a challenge there that needs to be made
unfortunately in any
you're going to have probably less than 60 days to get all of your paperwork
together
and your arguments in mind and over to medicare before their decision on your
appeal is made, if you'd like to know more about Medicare appeals
or the notice of overpayment process
in general you can order a copy of my book a physician's guide
or you can visit us at www.businessandhealthlaw.com