Medicare and Medicaid audits are increasing sharply. In this Managed Care Contracting and Reimbursement Advisor article, Steve Azia notes that an increasing threat to physician practices is a tool, used by the various auditors, called extrapolated overpayments. For example, the auditor may look at a sample of 30 of the physician's claims and find an error rate of 60%. They then extrapolate that error rate to a much larger universe of claims by that practice.
"You may have an initial overpayment of $10,000 that becomes a $1 million extrapolated overpayment," Mr. Azia explains. "It is a very dangerous situation facing providers."
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