What is an improper payment?

January 1, 2009

What is an improper payment?

What is an improper payment?

In July 2008, CMS published a summary on the RAC program’s first phase. Physicians unfamiliar with RAC might take heed of what constitutes an overpayment. Improper payments on claims can include, but are not limited to:

An underpayment usually occurs when the provider submits a claim for a simple procedure, but the medical record indicates that the provider actually performed a more complicated procedure that required greater reimbursement.