Anesthesia Business Consultants reports CMS clarified the overpayment rule, stating the overpayment occurs when the provider “has, or should have through the exercise of reasonable diligence, determined that the person has received an overpayment and qualified the amount of the overpayment.” From that moment, the provider has 60 days to repay Medicare.
The physician must conduct an investigation of the payment within six months of receiving the payment, with extraordinary circumstances as an exemption.
The Final Rule also defines the look back period as six years instead of 10 years, which was outlined in the proposed rule. The overpayment only needs to be returned if identified within six years of receiving the overpayment.
CMS also outlined methods for reporting and returning the overpayment in the Final Rule and those that aren’t compliant could be subject to False Claims Act or Civil Monetary Penalties Law liability. The rule went into effect yesterday.
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