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  • Quick Quiz: When Medicare Says You've Been Overpaid

    There you are, hard at work. Your patients are making progress, you're feeling good, things seem to be going along just fine, and then—boom—you get a letter from the Centers for Medicare and Medicaid Services (CMS) saying they think they've overpaid you on a claim. It's enough to ruin anyone's day.

    Think you know your way around the overpayment process? Take this quick quiz, and then check out this CMS fact sheet for more details on the options available to you if CMS says you’ve been overpaid on a claim. (Quick tip: When it comes to the overpayment process, deadlines matter and are taken seriously. The CMS fact sheet also lays out timelines clearly—you may want to keep a copy handy.)

    Ready? Here we go.

    1. Overpayments above which amount will trigger the Medicare Administrative Contractor (MAC) recovery process?

    A. $5
    B. $10
    C. $25
    D. $50

    2. If you don't repay the alleged overpayment (or submit a rebuttal to the MAC), when does interest begin accruing?

    A. On the initial notification
    B. 30 days after notification
    C. The next quarter of the year
    D. Upon submission of a subsequent claim for reimbursement

    3. Which of the following is NOT an option if you receive an overpayment demand letter?

    A. Make an immediate payment
    B. Request that the overpayment be immediately recouped through reductions in current due or future claims you've submitted or will submit ("immediate recoupment")
    C. Request that the MAC reduce your payments on claims beginning 16 days after the demand letter was issued ("standard recoupment")
    D. Request an extended repayment schedule (ERS)
    E. Submit a rebuttal explaining why Medicare shouldn't begin recoupment
    F. Request a redetermination to appeal the overpayment determination
    G. Ignore the whole thing and binge-watch "American Gladiators"

    4. True or false: It's possible for an appeal to an overpayment determination to be decided in Federal District Court.

    5. How many days after a demand letter is sent do you have to request an appeal of the determination and stop recoupment?

    A. 7
    B. 15
    C. 30
    D. 60

     

     

    Answers: 1-C; 2-B; 3-G; 4-True; 5-C.

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