A. Medicare may review patient records for up to two years during a post-payment audit. Some providers are required to refund substantial sums of money as a result. Know about appeal rights, and take advantage of them. Do so by writing the carrier and explaining clearly and in detail why each service in question is reasonable and necessary. At the same time, request a formal hearing in case the results of the reconsideration are unsatisfactory.
Providers stand the greatest chance for a favorable outcome if they appear in person for a hearing.
Since Medicare requirements vary among geographic areas, the local insurance carrier for the program and the appropriate state psychological association are good information contacts.