Reimbursement

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Friday, April 30, 2004

Post-pay review tips
With Maureen Hanna
M. Hanna

Q. In post-payment Medicare audits, what insight can you provide to suppliers for best presenting their case?

A. I often see providers merely attaching documents in no particular order and send the package off to Medicare. I recommend:

- Enclosing a cover letter that briefly explains your documents.

- Place documents in the same order as Medicare requests them (e.g. in alphabetic order by beneficiary name and the attachments documents in the same order as the Medicare request).

- Create a cover sheet for each patient. List the document you are enclosing. If documents are not applicable to that patient state so in the cover letter.

- Audit your records before Medicare does. Perform a full due diligence on the record.

- If you have been paid incorrectly, immediately make the refund. In the cover sheet make a reference to the refund.

- Make copies of both the front and back of all documents.

- Retain copies of all documents sent to Medicare.

Always make sure that you are addressing the regulations at the point in time for the date of service under audit. Regulations today do not apply to service dates in 2002. Retain all supplier manual updates.

Contact Maureen Hanna at Healthcare Reimbursement Consultants: 480-837-3229.

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