Overpayments and Underpayments: What You Need to Know

Key Takeaways:

  • Quarterly self-audits will help you identify underpayments and overpayments.
  • You must self-report overpayments within 60 days of becoming aware of them – failure to do so can expose you to fines, penalties and even loss of credentialing.
  • Focus on your E/M codes – they are often audited by CMS because they are common areas of deficiency.
  • For 2021 there are new guidelines and code descriptors for E/M codes – makes sure you know and understand how to use them
  • To avoid underpayments, make sure you are being paid your contracted rate; also verify that your fee schedule matches your contract.

Underpayments and overpayments are common – and both can be problematic for eyecare practitioners. If you are being underpaid, you are leaving money on the table. If you are being overpaid, you are required to refund the money within 60 days of becoming aware of the credit balance (overpayment). Practices that drag their feet on this are exposed to legal action under the False Claims Act.

It’s tempting the think your eyecare practice will fly under the radar. That’s a mistake. Private practices get audited by the Centers for Medicare & Medicaid Services (CMS) and private payers every quarter. Here’s how you can protect yourself.

Read the full blog post on the Alta Medical Management website.

About the author:
Jacqueline Todd-Washington, VP of Revenue Cycle Management, Alta Medical Management

Jacqueline has over 35 years of experience in Revenue Cycle Management, helping practices of all sizes and across multiple specialty areas capture the revenue they deserve. Her motto is, “It’s your money!” and she loves to share her knowledge with anyone who asks.

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