If Medicare makes a mistake, must I notify officials there?



Question: Medicare’s final demand letter omitted bills from three treating physicians. Do we have to inform Medicare of its apparent error?


Answer: There is no federal regulation which obligates you to make Medicare aware of its oversight. However, Medicare has the right to seek reimbursement after the final demand, if additional injury related claims are paid. Because providers have up to one year to submit claims to Medicare, keep in mind that all charges may not be fully represented on the final demand, depending on the timing of the case. Often times, Medicare does not re-open a case after the issuance of the final demand. However, if you or your client were to seek administrative remedies such as an appeal, Medicare could add those missing claims at that time.

Many folks who have this or similar questions are frustrated by the Medicare reimbursement process, and would prefer that their practice become more efficient and profitable by working with a healthcare compliance consultant to address these reimbursement issues. They would rather focus their energy on other client needs instead of working on lien issues. If you are interested in making your firm more efficient and profitable, please call us and we can tell you exactly how to make that happen immediately.

Medicare Set Aside Services

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