Payers, Policy

CMS: Return Medicare/Medicaid overpayments within 60 days

CMS released a pre-publication version of the rule Thursday. The rule will take effect 30 days after it officially appears in the Federal Register, which is scheduled for Friday.

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In a move intended to reduce fraud and waste, the Centers for Medicare and Medicaid Services finalized regulations that call on providers to report and return overpayments within 60 days of identifying a discrepancy. Medicare Parts A and B and Medicaid providers have to explain the reason for each overpayment as well.

CMS released a pre-publication version of the rule Thursday. The rule will take effect 30 days after it officially appears in the Federal Register on Friday.

“The requirements in this final rule are meant to ensure compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against fraud and improper payments,” CMS said. “An overpayment must be reported and returned regardless of the reason it happened – be it a human or system error, fraudulent behavior or otherwise.”

This rule stems from another obscure provision of the Affordable Care Act, one you won’t hear about from political types who just want to argue about insurance coverage, but it’s not the first time CMS has tried to implement such a rule.

The Health Care Financing Administration, the precursor to CMS, proposed overpayment rules in 1998. Following the name change, CMS tried again in 2002, according to the new document.

CMS has had overpayment rules for Medicare Parts C and D in place since 2014.

Photo: Bigstock

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