CMS Issues Final Rule on Reporting and Returning Medicare Program Overpayments.

Date posted: March 1, 2016

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule implementing the 60-day deadline to report and return Medicare overpayments.  The 60-day deadline is counted from the later of: (1) the date an overpayment is first identified; or (2) the due date of any corresponding cost report.

Key provisions of the final rule include the following:

  • The rule applies to Medicare Part A and Part B providers and suppliers;
  • Providers must use an applicable claims adjustment, credit balance, self-reported refund, or another appropriate process to satisfy the repayment and reporting obligation;
  • The look-back period has decreased from 10 years to 6 years; and
  • Providers or suppliers that report a self-identified overpayment and follow reporting protocol will be considered in compliance with the rule.

Significantly, the final rule defines “identification” of an overpayment.  The rule states that an individual has identified an overpayment when the individual “has or should have, through the exercise of reasonable diligence, determined” that the individual has “received an overpayment and quantified the amount of the overpayment.”  CMS stated this new standard strikes the appropriate balance of firm accountability and the flexibility to apply to various circumstances.

The final rule will take effect on March 14, 2016.

The final rule is available at:

https://www.gpo.gov/fdsys/pkg/FR-2016-02-12/pdf/2016-02789.pdf.

The CMS press release is available at:

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-11.html.

Medicare Program; Reporting and Returning of Overpayments; Final Rule, 81 Fed. Reg. 7653, 7653-7684 (February 12, 2016).

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