Definition of Medicare Overpayment

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Posts: 46
Joined: Fri Aug 03, 2012 10:22 am

Wed May 16, 2018 10:08 am

Hi. I've read Medicare's definition of an overpayment but am somewhat unclear on the application. If a provider has sufficient documentation to support that a service was rendered as billed but the documentation is missing an element required by the MAC, does this constitute an overpayment? For example, a provider has performed prolonged services in addition to an E/M. The provider has documented the total visit time which supports the prolonged service. However, the MAC states start/stop times should be documented for a prolonged service, but they are not documented in this hypothetical scenario. Is this considered an overpayment by Medicare's definition? Or is it not an overpayment, since the documentation supports the prolonged service was rendered as billed (since the total time is documented, although missing the specific start/stop times)? Thanks for any clarity you can provide regarding real-life examples of what is and what is not an overpayment from Medicare's perspective.
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