The Centers for Medicare & Medicaid Services has established that health providers must report overpayments going back six years rather than 10.
The controversial rule about overpayments was first introduced as part of The Affordable Care Act, which dictates that providers must return overpayments within 60 days of identifying them or else be subject to financial penalties under the False Claims Act.
From Modern Healthcare:
The rule, first proposed in 2012, alarmed many healthcare organizations when the CMS floated the idea that providers would be liable for returning Medicare overpayments going back as far as 10 years. The American Hospital Association and the Federation of American Hospitals criticized the proposal at the time, saying the time frame was unreasonable.
In response to these objections, the CMS said the period will now be six years. Many providers and suppliers retain records and claims data for between six and seven years based on various existing federal and state requirements.
“Thus, we believe our final rule does not create additional burden or cost on providers and suppliers in this regard,” the CMS said in the rule.
Still, industry stakeholders were disappointed.
“We had requested a three year look back period, but six is better than 10,” said Wanda Filer, President of the American Academy of Family Physicians.
Medicare Administrative Contractors were previously only allowed to reopen claims from 48 months (four years) before or fewer.
Photo by Anoto AB via Flickr CC License.
