Overstated Payment Amounts In Medical Billing

Watch Overstated Payment Amounts In Your Medical Billing

The state of Indiana is raising some eyes in the medical billing world. The Centers for Medicare & Medicaid Services have strict regulations for payments and upper payment limits (UPLs). Apparently Indiana significantly overstated these amounts, which led to large over payments. Now, the Indiana medical billing overstatements may affect their bottom line.

The Office of Inspector General announced that for the Indiana state fiscal years 2001 and 2002, they overstated upper payment limits by about $6.5 million. The medical billing in 2001 was overstated by $2.2 million, and 2002 medical billing was overstated by $4.3 million.

The reason these medical billing amounts were severely overstated is because Indiana used unpaid Medicaid claims AND paid claims to calculate the upper payment limits. Many of the unpaid claims were unpaid because they were uncovered services under plan provisions. They should have never been calculated in the medical billing upper payment limit formula.

Indiana must have had quite a few medical billing problems during this time because they also miscalculated in another manner. They used incorrect cost-to-charge ratios which not only led to overstatements, but also understatements for one hospital.

To refund Medicaid for the medical billing over payments, the Office of Inspector General stated that Indiana will have to pay back over $3 million. This aback may severely harm the state’s bottom line. To prevent this type of a aback from occurring, be sure you strictly follow CMS medical billing guidelines. It has been proven that medical billing payments years earlier can be revoked if they are found to be inaccurate. Your best safeguard to protect your practice is to hire medical billing staff members you can trust. These staff members must know the medical billing world in and out. Their medical billing knowledge will lead to your success.

View all Articles by: Melissa Clark, CCS-P