The current Fee-For-Service (FFS) payment model for reimbursing healthcare providers functions as a pay-and-chase model, meaning you get paid for services under the presumption that the provider represented the services they rendered accurately and in accordance with various regulatory requirements.  When organizations bill for services, they are reimbursed on a good-faith basis with the expectation that clinical documentation supports the services reported.  This pay-and-chase model creates a false sense of security for healthcare providers that mistakenly assume because they got paid for something means they are doing everything compliantly.  This assumption could not be further from the truth.  Just because you got paid, doesn’t mean you billed services compliantly. 

Clinical documentation deficiencies, coding and billing errors, compliance risks, and overpayments are most often identified in post-payment audits that occur retrospectively (meaning after the services were already paid for by a third-party).  Payer Audits and Recoupments are insidious and can lead to catastrophic consequences for healthcare providers. Many healthcare organizations fail to self-report and refund identified overpayments, which is mandated and required by the Social Security Act.  Overpayments can occur for a number of reasons, including coding errors, insufficient documentation, inadequate supervision, lack of medical necessity, ineligible billing provider, etc. 

This webinar will define overpayments in various examples, unpack the requirements for self-reporting, unravel the pathways for which self-reporting can take place, spotlight the consequences of not self-reporting, discuss timelines and look-back periods for self-reporting, and so much more.