Improper Payment Review
Improper payment review is the auditing process payers and oversight bodies use to identify claims paid in error, whether overpayments, underpayments, or payments lacking documentation. ASCs face these reviews from Medicare contractors and must produce records to defend reimbursed claims.
What is an improper payment review?
An improper payment review is an audit process used by payers and oversight bodies to identify claims that were paid in error. The errors at issue include overpayments, underpayments, and payments that lack the documentation needed to support them.
These reviews examine whether what was paid matches what was billed, coded, and documented for the service. When a discrepancy is found, the payer may seek to recover an overpayment or correct an underpayment.
Why does improper payment review matter for ASCs?
Ambulatory surgery centers are subject to these reviews from Medicare contractors and other payers, and must be able to produce records that justify the claims they were paid for. A review that finds inadequate documentation can lead to recoupment, even when the care itself was appropriate.
Because the burden falls on the provider to defend a paid claim, complete and well-organized documentation is the center's best protection. Anticipating these reviews encourages disciplined record-keeping that holds up under audit.
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