CMS Relaxes Lookback Period for Medicare Overpayments

The Centers for Medicare & Medicaid Services (CMS) has spoken, finalizing a controversial rule and relaxing the lookback period physicians must adhere to when returning Medicare overpayments. In 2012, CMS proposed requiring physicians to return Medicare overpayments going back 10 years. The agency announced last week the required lookback period will be six years. 

Under the Affordable Care Act, physicians who determine they've received Medicare overpayments must report and return them within 60 days to avoid liability under the False Claims Act. Physicians must look back through six years' worth of records for excess Medicare payments.

"Creating this limitation for how far back a provider or supplier must look when identifying an overpayment is necessary in order to avoid imposing unreasonable additional burden or cost on providers and suppliers," states the final rule.

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 Reimbursement Review and Resolution Service 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, Feb. 16, 2016

Last Updated On

November 20, 2020

Originally Published On

February 11, 2016

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