Understanding overpayment demands and the rules and regulations behind them will help you maintain the integrity of the healthcare system. The goal of this webinar is to explain why it’s important to review and address overpayment demands in a timely manner.

Integrity Matters When Handling Overpayment Demands

Overpayments can occur due to errors, fraud, or abuse, and identifying these overpayments is crucial to maintaining the integrity of the healthcare system. The goal of this webinar is to explain the meaning of overpayment demands, and why it is important to review and address them in a timely manner. We will discuss examples of federal and commercial payer overpayment demands and how to handle them properly. This webinar will cover rules and regulations behind the False Claims Act, Fraud Enforcement and Recovery Act, Affordable Care Act, and Employee Retirement Income Security Act (ERISA).

One way an overpayment can occur is when incorrect payment is collected from the patient at the time of service. Other ways are due to processing and administrative errors, incorrect coding, insufficient documentation, and medical necessity errors. We’ll dive into ways that medical practices can be proactive to reduce overpayment demands. We’ll explore best practices to help ensure the accuracy and integrity of your healthcare billing to protect yourself and your practice from unnecessary legal implications due to overpayments.

A question example from the webinar: What is the main difference between a professional provider audit and a professional medical coder audit? Short answer: For a physician audit you are checking the medical record for accuracy and if they are including all relevant and complete documentation. When you are auditing medical coding, you are checking how the coder abstracted the codes from the provider documentation.

This webinar ends with a Q & A session. By the end of it, providers will feel more confident in their healthcare organization’s coding decisions and have peace of mind with their compliance practices.

Learning Objectives/Agenda

• About the meaning of overpayment demands and the rules and regulations behind them

• Ways to reduce and prevent the risk of overpayment demands

• Medicare, commercial payer, and patient overpayment requirements

• Ways to properly handle an overpayment demand

• Industry best practices

Why is this topic important?

It is important to understand rules and regulations related to overpayment demands to reduce and avoid penalties and stay compliant in the healthcare industry. Overpayments represent funds that have been incorrectly paid out and should be returned. Troubleshooting, avoiding, and correcting overpayments will help to prevent financial loss for healthcare providers and insurance companies.

There are strict rules governing healthcare billing, and failure to address overpayments can result in penalties or legal action. Handling overpayment demands promotes fairness and equity in the healthcare system because overpayments can lead to higher costs for everyone, so addressing them helps to keep healthcare affordable.

Who would benefit from this topic?

• Medical practice owners
• Medical providers
• Practice managers
• Medical billers
• Medical practice staff
• Compliance officers

What’s the presenter's background/expertise on this topic?

Gilman has over two decades of revenue cycle management experience in the healthcare industry. She is an expert at uncovering and correcting all billing inefficiencies and errors, while streamlining operations to achieve maximum results. Gilman is an expert coder and compliance officer, who trains healthcare providers all over the country. Her successes include small and large practices, ranging from primary care to specialists and surgeons. Gilman is known for keeping accounts receivables as low as possible, while ensuring collections are optimized. Her acute attention to detail, deep understanding of coding and billing, and proactive approach, make her an indispensable asset with all her clients.

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