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CMS clarifies final overpayment rule: 5 things to know

The Centers for Medicare & Medicaid Services published the final rule on self-identified overpayments for Medicare Part A and B.

Here are five key notes:

1. Overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the organization received an overpayment. The organization must report the overpayment within 60 days of identification.

2. Providers and suppliers must use the applicable claims adjustment, credit balance, self-reported refund or another appropriate process to satisfy the obligations to report and return overpayments.

3. If the healthcare provider reports a self-identified overpayment to CMS's self-referral disclosure protocol or the OIG's self-disclosure protocol, the provider or supplier is in considered in compliance with the rule provisions as long as they are actively engaged in the respective protocol.

4. Organizations that fail to report and return an overpayment could face False Claims Act liability, Civil Monetary Penalties Law liability and exclusions from the federal healthcare programs.

5. Under the final rule, a person has identified an overpayment when the person has or should have, through reasonable due diligence, determined the person received an overpayment and quantified the amount of the overpayment.

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