On the lookout for overpayments

Friday, March 23, 2012

YARMOUTH, Maine - It turns out disclosing and returning identified overpayments to Medicare is just another part of the job for HME providers.

Ninety-seven percent of providers have been overpaid by Medicare and have returned the money, according to a recent HME NewsPoll.

"Of course we identify and return overpayments," said Lori Sears, owner of Lapeer, Mich.-based Active Home Medical Supply. "Does it kind of kill me to do it when Medicare is taking so many overpayments so unfairly? Of course it does. But at the end of the day, our integrity might be all we have left."

A large majority of providers (93%) also say they have polices and procedures in place to help them identify overpayments.

Providers not only return money to Medicare, but they do it on a fairly regular basis, they say.

"We return overpayments nearly every month," said one poll respondent. "We document the voluntary refunds so, in the event that we are ever subject to adverse action, we can demonstrate we do issue voluntary refunds when overpayments are identified."

Overpayments can happen for a number of reasons, but one of the biggest reasons is a patient being admitted to a healthcare facility. The two main methods of detecting these and other overpayments: computer software tools and old-fashioned legwork.

"We have a chart review process that reviews prior to billing for documentation, after billing to check a second time, and again upon payment of the claim," said Polly-Jo Hightower, president of Alpert's Medical Equipment & Supply in Keyser, W.Va. "We contact our patients on a regular basis, checking for facility admissions and home health events."

Providers say monitoring accounts and returning overpayments--regardless of the payer--is just part of doing business.

"The policy is simple," said Paul Reses, owner of Pleasantville, N.J.-based Lincoln Medical Supply. "If we get paid for something that we shouldn't have, we return the money--any insurance, any company, any customer."