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With every new year, a new lookback period for Medicare claims audits

Raja Sékaran (rsekaran@nossman.com) is a Partner in the San Francisco office of Nossaman LLP.

Voluntary self-audits of Medicare claims should be part of any provider’s compliance program. For fee-for-service claims, these often focus on coding and billing of services. Both for purposes of defining the audit universe and for issuing refunds when appropriate, this article offers a consistent approach to defining a lookback period for auditing, and possibly refunding overpayments to, Medicare.

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