Overpayment Recovery and Claims Appeals
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.
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.