CMS has codified the longstanding responsibility of providers and suppliers to report and return Medicare Part A and B overpayments. Specifically, the Final rule requires health care providers and suppliers receiving funds under the Parts A and B programs to report and return overpayments by the later of the date that is 60 days after the date an overpayment was identified, or the due date of any corresponding cost report. The Final rule will officially publish on February 12, 2016, and will be effective 30 days after publication. A previous Final rule published on May 23, 2014 (79 FR 29844) addressed Medicare Parts C (42 C.F.R. sec. 422.326) and D (42 C.F.R. sec. 423.360) overpayments (see Medicare Parts C and D 2015 participation requirements and payment accuracy addressed, May 27, 2014).
Significant provisions. The three most significant provisions of this Final rule include clarifications of: (1) the meaning of overpayment identification; (2) the required lookback period for overpayment identification; and (3) the methods available for reporting and returning identified overpayments to CMS. The Final rule sets forth the following requirements with regard to these three provisions:
- Overpayment identification. A provider or supplier is deemed to have identified an overpayment when the provider or supplier has or should have, through the exercise of reasonable diligence, determined that the provider or supplier has received an overpayment and quantified the amount of the overpayment. This standard provides needed clarity and consistency for providers and suppliers on the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments.
- Lookback period. Overpayments must be reported and returned only if the provider or supplier identifies the overpayment within six years of the date the overpayment was received.
- Methods for reporting and returning overpayments. Providers and suppliers must use applicable claims adjustment, credit balance, self-reported refund, or another appropriate process to report and return overpayments. This will preserve CMS’ existing processes and its ability to modify these processes or create new processes in the future.
Tomorrow’s Health Law Daily will include a full analysis of this Final rule.
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