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CMS issues final rule on reporting, returning Medicare overpayments

CMS on Friday published a final rule requiring Medicare Parts A and B health care providers and suppliers to report and return overpayments either within 60 days of the overpayment being identified, or by the due date of any applicable corresponding cost report.

The final rule also includes several clarifications, covering the required lookback period for overpayment identification, the available methods for report and returning overpayments to the CMS, and a definition of “overpayment identification.”

“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,” according to a CMS press release announcing the final rule. “This rule clarifies requirements for the reporting and returning of self-identified overpayments.”

According to the CMS, the Affordable Care Act requires a person who receives overpayments to report and return the amount by “the later of the date which is 60 days after the date on which the overpayment was identified, or the date any corresponding cost report is due, if applicable.”

The CMS in February 2012 proposed making a final rule applying those provisions of the Affordable Care Act to Medicare Parts A and B providers. A final rule addressing Medicare Parts C and D was published in May 2014.

In the new published rule, a health care provider or supplier has identified an overpayment when they have, “or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment, and quantified the amount of the overpayment.”

In addition, overpayments are to be reported and returned only if the health care provider or supplier identifies the error within a lookback period of 6 years to the date the overpayment was received.

When making a repayment, the rule requires health care providers and suppliers to use “applicable claims adjustment, credit balance, self-reported refund, or another appropriate process,” according to the CMS.

According to CMS: “Health care providers and suppliers will also continue to be required to comply with current CMS procedures when we, or our contractors, determine an overpayment exists and issue a demand letter.” – by Jason Laday

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