CMS Clarifies Medicare Overpayment Reporting Requirements

CMS Clarifies Medicare Overpayment Reporting Requirements

A final rule, issued by the Centers for Medicare & Medicaid Services (CMS) on Feb. 12, clarifies reporting and repayment obligations for providers and suppliers who receive a Medicare overpayment.

The final rule explains, “a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment.”

When Reporting, Timing is Everything

Effective March 14, 2016, Section 1128J(d)(2) of the Social Security Act — as amended by Section 6402(a) of the Affordable Care Act — requires an overpayment to be reported and returned within 60 days after the date on which the overpayment was identified; or the date any corresponding cost report is due, if applicable. Providers and suppliers must also notify the secretary of the U.S. Department of Health & Human Services, the state, an intermediary, a carrier, or a contractor of the reason for the overpayment, in writing.

The final rule also clarifies that overpayments must be reported and returned only if a person identifies the overpayment within 6 years of the date the overpayment was received.

Providers and suppliers could face potential False Claims Act liability, Civil Monetary Penalties Law liability, and exclusion from federal healthcare programs for failure to report and return an overpayment.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

One Response to “CMS Clarifies Medicare Overpayment Reporting Requirements”

  1. Teri Vazquez says:

    I have submitted a refund request to Medicare, they have sent it back to me. They state our electronic clearinghouse needs to submit it electronically. They tell me they do not know how to do, that Medicare needs to tell them how. Medicare tells me that they should know how. I send a check and the paper work to CGS Medicare and they send it back. What do I need to do to get them to take my refund. I called and spoke to CGS, they do not accept any paper work on a refund. The check was returned to us.

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