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Overpayment Recovery and Claims Appeals

Ensuring proper processing and payment of health care claims is vital to the financial health of a physician practice. However, addressing claims payment issues can be complicated, challenging and administratively burdensome for practices. Whether a physician’s office is navigating the overpayment recovery process or appealing a perceived underpayment, the AMA offers resources to help physicians secure correct claims payment from health plans.

Identifying and Appealing Claims Payment Issues

With claims payments accounting for the majority of revenue for many physician practices, practices should understand how to verify the accuracy of health plan payments and appeal improper payment decisions, when necessary. 

In order to help physicians understand and enact efficient appeals processes, the AMA has created Claims Appeals Resources.

Access these resources

Overpayment Recovery Toolkit

Attempting to determine the validity of alleged overpayments can divert significant time from direct patient care, which results in lost practice revenue. Overpayment demands may be made in very general terms and may also be intimidating. However, it is critical for physician practices to effectively and efficiently address overpayment recovery requests.

In order to help physicians understand and address health insurer overpayment recovery requests, the AMA has created the Overpayment Recovery Toolkit.

Access this resource

LinkedIn Discussion Group
Join discussions in the AMA Administrative Simplification LinkedIn Group.