3 things you must know about overpayment recovery


When a payer sends an overpayment recovery request—a retroactive denial or reduced payment of a previously paid claim—you may lose significant time from patient care while handling the issue. Learn what you need to know about the overpayment recovery process with these three tips and additional assistance from a free online overpayment recovery toolkit from the AMA. 

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  1. Address the request as soon as possible. You have the right to challenge a request, but there may be defined time constraints for doing so in your contract with the health insurer. In some cases, the insurer will automatically recoup the payment if it doesn’t receive a check or appeal within a specified period of time. Learn how to address and resolve overpayment recovery requests.
  2. Improve your practice’s administrative workflow by automating the overpayment recovery process. Keeping track of overpayment recovery requests and using a payer follow-up log will help improve your practice’s process. Using electronic transactions to automate and standardize workflows in your practice can reduce the likelihood of these requests. Get more information on how to automate the tracking and monitoring process.
  3. Know your overpayment recovery rights. Many contracts between physician practices and insurers place few, if any, restrictions on the payer’s ability to recover alleged overpayments. However, you may have rights that, when exercised, can greatly reduce the administrative burdens these processes place on your practice. For example, 24 states have passed statutes or regulations that give physicians significant protections with respect to overpayment recovery practices. Find out more about your rights in this process.

Other newly updated resources available on the AMA’s overpayment recovery web page can help you automate and improve the process for overpayment recovery.