Tag Archives: Medicare Learning Network fact sheets

ILN Today Post

Federal and commercial payor medical record requests are important – Don’t dismiss them!

It is becoming more and more common for providers to receive what appear to be innocuous medical records requests from both federal and commercial payors. These requests are typically based on data analytics available to the payor that identify the provider as an outlier in some respect. Payors use the analytics to look for potential overpayment issues. Unfortunately, most providers do not understand the significance of these requests and the impact that an incomplete response can have on a future potential overpayment demand and/or possible imposition of a payment suspension by Medicare or a commercial payor.

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