CMS eases final rule requiring providers, suppliers to report overpayments
- This morning, the CMS published a final rule that requires Medicare Parts A and B providers and suppliers to report and return overpayments by 60 days after the date an overpayment was identified.
- Under the rule, overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received.
- In May 2014, a separate final rule was published to address Medicare Parts C and D overpayments.
According to the agency, "The requirements in this rule are meant to support compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against improper payments, including fraudulent payment."
The rule was first proposed in 2012, according to Modern Healthcare. The proposed rule caused quite a fuss as it "floated the idea that providers would be liable for retunring Medicare overpayments going back as far as 10 years."
The rule sets to clarify requirements for the reporting and returning of self‑identified overpayments. The major provisions include clarifications around: The meaning of overpayment identification; the required lookback period for overpayment identification; and the methods available for reporting and returning identified overpayments to CMS.
According to the rule, an overpayment must be reported and returned by the later of: (i) the date which is 60 days after the date on which the overpayment was identified; or (ii) the date any corresponding cost report is due, if applicable. "Creating this standard for identification provides needed clarity and consistency for healthcare providers and suppliers regarding the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments," CMS stated in a prepared release.
Under this final rule, overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received.
How to report overpayments
Additionally, the final rule provides that providers and suppliers must use an applicable claims adjustment, credit balance, self‑reported refund, or another appropriate process to satisfy the obligation to report and return overpayments.
Will it be supported?
The actions come after findings that improper reimbursement to Medicare Advantage plans by the federal government, mostly resulting from overbilling, totaled nearly $70 billion from 2008 through 2013, according to a 2014 analysis by The Center for Public Integrity.
Additionally in 2014, an Office of Inspector General report said Medicare overpaid doctors by $6.7 billion in 2010, suggesting widespread physician upcoding.
While overpayments are a problem, the agency has been receiving pushback over such regulations. Earlier this month, UnitedHealthcare and 41 other payers sued HHS in an effort to bar the Medicare Advantage final rule on overpayments. Simliarly to the rule published today, the rule required overpayments to be reported and repaid within 60 days of being identified. The complaint alleges CMS’ 2014 rule sets a different bar for assessing health claims for Medicare Advantage and fee-for-service beneficiaries, in violation of the Medicare Act.
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