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Statute of Limitations for Billing Dispute with Medicare

Mary R. Daulong, PT, CHC, CHP

June 7, 2012

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Question

What is the statute of limitations for billing issues?  How long can Medicare come back and audit?  

Answer

Typically they audit for up to 3 years.  The RAC does have some limitations as well.  If there is suspected or discovered fraud, they can go back indefinitely.  I have seen this as well.  When I have done chart audits and we have self-discovered, we try to do a sampling so that if we have refunding, we are looking at the kind of sampling that they would do, although we would not extrapolate.  You want to make certain that you look at a good sampling if you find that you do have some violations or over-payment .  


mary r daulong

Mary R. Daulong, PT, CHC, CHP

Mary Daulong, PT, CHC, CHP has a very diverse practice background which includes private practice ownership, corporate managed services and hospital based practice exceeding four decades. Her consulting company was established in 1985 and has been, for the past ten years, 100% dedicated to working with healthcare professionals in the areas of federal and state compliance, practice and business office operations, payment and coverage policy including billing, coding and documentation. Her company also provides rehabilitation specific compliance policy and procedure manual production and provider enrollment services.

Mary has been certified in Health Care Compliance since 2002 and is a member of the Healthcare Compliance Association she is also certified as a HIPAA Professional by the HIPAA Academy. Mary has been an active member of the APTA and just recently served as its Risk Management Committee chair. She is a member of the APTA’s State Reimbursement Chair Forum and has held the position of Chair of the Texas Physical Therapy Association’s Payer Relations and Payment Policy Committee for nearly six years.  She served for five years on the Texas Board of Physical Therapy Examiners as well as was a member of its Executive Council for PT and OT and Investigations.

 Mary has presented well over one hundred (100) courses related to compliance both on a federal and state level often being the featured speaker at National, Chapter and Section Annual Conferences.


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