CMS 60-Day Repayment Final Rule
CMS issued its final rule for the 60-day repayment regulation on February 12, 2016. The final rule requires the timely refund of any overpayment identified by a provider. The effective date of the final rule is March 14, 2016.
Most health care attorneys believe the final rule is a fair approach to this issue. The various health care business groups will monitor how each Medicare contractor implements the final rule.
Highlights of the final rule are as follows:
- Any Medicare payment received or retained by a provider organization that they are not entitled to is an overpayment. This could be receiving a payment in error from a Medicare contractor.
- The 60-day period starts after a provider has identified and quantified the overpayment amount using reasonable due diligence.
- To exercise reasonable due diligence you need to conduct proactive and reactive investigations.
- Most investigations are expected to be complete in 8 (6 months to investigate and quantify the amount, plus the 60-day repayment period).
- If CMS determines that no reasonable due diligence has taken place, then the 60-day period starts at the date of identification.
- If a repayment issue is based on a systemic problem, the provider has to go back 6 years to calculate the repayment amount. The proposed rule called for a 10-year look back period, so the Final Rule was less punitive.
- All report and refund forms plus procedures should be used by the Medicare contractor who made the overpayment to the provider.