Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3

Assessing Overpayment or Potential Overpayment When Review

Last amended: 2016Year: 2016Length: 86 wordsOfficial source
8.2.3 – Assessing Overpayment or Potential Overpayment When Review Was Based on Limited Sample or Limited Sub-sample (Rev. 670, Issued: 08-19-16, Effective: 11-23-16, Implementation: 11-23-16) If a limited sample or limited sub-sample of claims is chosen for review, there are two overpayment assessment options for contractors: • Refer to overpayment staff for recoupment of the actual overpayment for the claims reviewed; or • Conduct an expanded review based on statistical sampling for overpayment estimation instructions in section 8.4 of this chapter and recoup the projected overpayment.
Medicare Program Integrity Manual (Pub. 100-08), Ch. 8 § 8.2.3: Assessing Overpayment or Potential Overpayment When Review | Justis AI