Feds Delay Final Medicare Overpayment Rule

The Centers for Medicare & Medicaid Services (CMS) announced last week it needs another year to finalize rules on reporting and returning Medicare overpayments. First issued three years ago to implement parts of the Affordable Care Act, the proposed rule (better known as the 60-day rule) requires physicians and other health care providers to report and refund overpayments within 60 days from the date the overpayment is identified or the date the corresponding cost report is due.

CMS's definition of when a payment is "identified" and the 10-year look-back period on claims that had not been identified garnered much industry criticism and pushback.

In its announcement explaining the year extension, CMS cited exceptional circumstances, including the rule's complexity and significant policy and operational issues raised by comments to the proposal, that need to be resolved.

With or without final rules, CMS warned stakeholders of their responsibility to return overpayments according to existing federal statutes or face penalties that include False Claims Act violations and exclusion from Medicare.

For more Medicare information, visit TMA's Medicare Resource page. For help with Medicare payment issues, email paymentadvocacy[at]texmed[dot]org, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Also, visit the TMA Payment Advocacy Services webpage and TMA's Payer page for more resources and information.

Action, March 2, 2015

Last Updated On

March 05, 2015

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