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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.

    Supervised Exercise (Still) Beneficial for Knee OA

    Most clinical practice guidelines recommend exercise as a first-line treatment for stiffness and pain in knee osteoarthritis (OA), and an updated Cochrane systematic review published in the British Journal of Sports Medicineindicates there's even more reason to do so.

    The authors examined 54 randomized clinical trials (RCTs) involving over 5,000 participants to determine the effectiveness of land-based exercise in improving pain, physical function, and quality of life in individuals with knee OA. Participants who completed exercise programs experienced moderate improvement in pain and physical function immediately after treatment, about the same as that of analgesics and nonsteroidal anti-inflammatory drugs.

    While pain relief from exercise was still significant at 2 to 6 months after treatment, the effect was smaller, and benefits were minimal after 6 months. Physical function improvement was "better sustained," according to authors, producing small yet significant results even at 6 months.

    New to this review was an analysis of data related to quality of life, where pooled results of 13 studies showed a statistically significant benefit of exercise immediately post treatment—"equivalent to an improvement of four points … on a 0–100-point scale," authors write.

    The review included studies that compared “any land-based non-perioperative therapeutic exercise regimen” with a non-exercise control group. This wide variation in exercise type, duration, frequency, and intensity didn't allow the authors to evaluate the benefits of one program over another. Also, these findings only pertain to strengthening or weight-bearing exercises—the authors found no studies that examined high-impact exercise as an intervention for knee OA.

    Researchers did find that supervised individual exercise programs were more effective than group exercise or home-based programs, with the authors writing that “the magnitude of immediate treatment effects of exercise on pain and physical function increases with the number of face-to-face contact occasions with the healthcare professional.”

    The new review updated an earlier Cochrane study on the topic completed in 2008. That study pointed to the positive effects of exercise for pain and physical function in individuals with knee OA.

    Eight years and 22 studies later, the evidence still supports that idea.

    "Health care professionals and people with OA can be reassured that any type of exercise program that is performed regularly and is closely monitored by healthcare professionals can improve pain, physical function and quality of life related to knee OA in the short term," they write.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.