CMS Overpayment Rule Overturned

Posted by Emerald Coast Medical Association on Sep 21, 2018 8:00:00 AM

The medical community has its own laws that can be changed. Often, these laws have a significant impact on the medical community and the way patients or physicians are handled. At Emerald Coast Medical Association, we strive to keep our members up to date on even the smallest of legal changes. 

Recently, Medicare Advantage insurers had a legal victory when a judge ruled that payers no longer have to report and return overpayments. According to the judge, the rule “violates the statutory mandate of ‘actuarial equivalence’ and constitutes a departure from prior policy that the government fails adequately to explain.” The previous law stated that any incorrect diagnostic code that was not documented in a patient’s chart could be classified as an overpayment.

More or less, the effect of the 2014 Overpayment Rule is that Medicare Advantage insurers are paid less to provide the same health care coverage that CMS pays for comparable patients. The 2014 ruling has now been overturned, which is a big deal for those in the medical field everywhere.

Currently, there is an ongoing fraud case against UnitedHealth. They have had numerous fraud cases against them, stemming from the government alleging the insurer submitted incorrect diagnosis codes even though they knew they were wrong. The new ruling will help stop fraud from happening, which will, in turn, benefit medical professionals and patients everywhere.

Emerald Coast Medical Association is proud to say that we can keep our members up to date on legal changes. This new ruling will significantly impact patients and physicians everywhere. If you haven't already, join us at our next member meeting for no charge, no strings attached.

Come see what ECMA is all about and why so many doctors love being a part of our community.

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Topics: Medical Law

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