Wiki Billing Audit

[ELITEMED1]

How far back should a billing audit be performed? I feel like it ought to go as far as when the issue of the problem originated. Is that correct? What if it may be over 10 years? Or is there a cut off timeframe with the OIG? If I remember correctly there was no cut off, but I found OIG article that indicated 6 year.

 

[TThivierge]

Hi EliteMed1
I have read somewhere the cutoff was 6 years can audit if payback needs to be done.
Lady T

 

[jkyles]

How far back should a billing audit be performed? I feel like it ought to go as far as when the issue of the problem originated. Is that correct? What if it may be over 10 years? Or is there a cut off timeframe with the OIG? If I remember correctly there was no cut off, but I found OIG article that indicated 6 year.

Hi there, if you're talking about performing an internal review, you can look back as far as you want.

The lookback period for external audits varies. I think you're talking about the lookback period for the 60-day overpayment rule. https://www.federalregister.gov/doc...ogram-reporting-and-returning-of-overpayments

b. Lookback Period​

This final rule states that overpayments must be reported and returned only if a person identifies the overpayment within 6 years of the date the overpayment was received. Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary in order to avoid imposing unreasonable additional burden or cost on providers and suppliers.

However, investigators can go back as far as 10 years when they have reasonable belief that the overpayments are the result of fraud.