Home Health & Hospice Week

You now have more time to appeal a Medicare recoupment -- but you'd better use your time wisely.

Recoupment allows contractors to recover a Medicare debt by applying Medicare payments to an outstanding bill, including overpayments resulting from Recovery Audit Contractor audits.

Previously the Centers for Medicare & Medicaid Services could recoup overpayments within 30 days of finding a debt -- whether or not you contested that you were ever overpaid.

New way: Beginning Nov. 16, CMS must wait until the Qualified Independent Contractor (QIC) issues a Reconsideration Decision at the end of the second appeal, according to a final rule published in the Sept. 16 Federal Register.

The rule comes after CMS took into consideration suggestions from the National Association for Home Care & Hospice (NAHC) that it give agencies 60 days to request a reconsideration before recouping overpayments. Once the request is filed, you then have the appeals period to work out whether the overpayment decision is correct. However, after your contractor issues a Reconsideration Decision, you have only 30 days to pay the debt or 15 days to seek an extended repayment plan.

Bonus: Thanks to NAHC's urging, CMS will instruct contractors to revise their overpayment demand letters to advise recipients of when they must file an appeal to cut off recoupment and that a debt's interest continues to build up during the recoupment limitation program.

The final rule gives you more time to prove that you were paid fairly for your services, but you may not have as much time as you think, notes Lester Perling, partner with Broad and Cassel in Ft. Lauderdale, Fla.

If you miss the recoupment due dates, "contractors will start recouping and will continue to do so until you file an appeal," Perling warns. Depending on how long it takes you to file an appeal, the contractor could recoup the entire payment -- and CMS won't pay interest on the funds wrongly collected.

Key: If agencies want to avoid recoupment, "they must carefully schedule requests for redeterminations and reconsiderations," Perling notes. For instance, you have a much shorter window for requesting those decisions than you do appealing them, he says.

You must also present enough evidence to warrant a reconsideration -- and you only have 60 days to gather it. "Some agencies may want to consider letting CMS recoup overpayments if they don't have enough  evidence for a reconsideration and they want to avoid paying interest," Perling suggests.

Resource: Access the final rule at http://edocket.access.gpo.gov/2009/E9-22166.htm.