3 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 6
I
t's hard enough to get your claims paid correctly. But to then
receive a refund demand several months or even years after you
submitted the initial claim presents a whole new challenge.
There is a way to fight back against medical record audit requests
and refund demands from payers or their third-party contractors.
Often, these attempts by insurers fail to meet various payer compli-
ance requirements that help protect revenue rightfully earned for your
services rendered in good faith. Compliance is a two-way street, and
payers are not exempt from claim-handling obligations. If you're fac-
ing refund requests or notifications of recoupment, here's what you
need to know.
When Payers Demand Refunds and Takebacks
Strategies to fight back and protect what's rightfully yours.
Coding & Billing
Karlene
Dittrich, CBCS, CPMA
• TUG OF WAR More and more payers are
demanding refunds and givebacks from facilities.
