Provided by:  Jennifer Kirschenbaum, Esq.

May 16, 2019

 

Question


Hi Jennifer,

I sent medical records in for review to a third party payor and now I received a letter demanding money back. Do I have to pay it? 

Thanks, 
Dr. L

Answer

Absolutely you should question a demand for repayment.  In many cases a repayment demand is based off of presumptions based on a sample of records that may not be representative of your practice, or results that are favorable to the third party payor.The rationale for the determination of the overpayment should be carefully considered, and challenged.

In rare instances, 100% of what is originally demanded will be due and owing after challenge.  Oftentimes in the case of a third party payor, other than Medicare or Meidcaid, there is room for negotiation and mitigation of amounts claimed owed.  

For more specific advice, we need to see the overpayment demand and discuss your practice.   Happy to help.  



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