A new report by the Government Accountability Office (GAO) shows physicians may face possible recoupments – or additional payment – for claims filed in 2023 as a result of over and underpayments by Medicare, Medicaid, and other federal programs.
The report found the majority of improper payments among government agencies came from Medicare and Medicaid programs, costing federal agencies $101.4 billion last year.
Texas Medical Association experts recommend physicians be aware of ongoing efforts to mitigate improper payments and to expect both potential recoupment and redistributed funds from these agencies.
The report examined 14 agencies that experienced improper payments across 71 programs. The improper payments that occurred across Medicare and Medicaid programs cost federal agencies approximately $51.1 billion and $50.3 billion respectively. This included:
- Medicare Fee-for-Service, with $31 billion in improper payments;
- Medicare Advantage (Part C), with $17 billion in improper payments; and
- Medicare Part D, with $3 billion in improper payments, indicating a $2 billion increase from 2022.
The GAO considers improper payments:
- Those that should not have been made;
- Payments made in an incorrect amount, including overpayments and underpayments; and
- Those that were made to the right recipient in the right amount but not in strict adherence to relevant statutes or regulations.
While approximately 74% of these improper payments included overpayments, the report also identified $11.5 billion in underpayments, defined in the report as “those in which recipients did not receive the funds to which they were entitled.”
The American Medical Association suggests physicians facing payment recoupment:
- Address recoupment requests as soon as possible;
- Improve their practice’s administrative workflow by using electronic transactions to automate the overpayment recovery process, keeping track of overpayment recovery requests, and using a payer follow-up log; and
- Know physician overpayment recovery rights that can “greatly reduce the administrative burdens” recoupment can have on practices.
Improper payments also occurred within the Department of Labor’s federal pandemic unemployment assistance program, the Department of Treasury’s Earned Income Tax Credit service, and the Small Business Administration’s Paycheck Protection Program loan forgiveness initiative, among others. For help with improper payment and other billing challenges, visit TMA’s Billing, Coding, and Reimbursement page.
Last Updated On
April 09, 2024
Originally Published On
April 09, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469