CMS 60-day rule

CMS issued a proposed rule for comments on “Reporting and Returning of Overpayments”. This rule, if finalized, would require persons (providers and suppliers) to “report and return overpayments by the later of the date which is 60 days after the date on which the overpayment was identified; or any corresponding cost report is due, if applicable.” CMS is proposing to implement section 1128J(d) of the Act for Medicare Part A & B providers and suppliers only at this time. This will be addressed at a later date for other “stakeholders” such as MAOs and Medicaid MCOs according to CMS.

CMS is planning to utilize the current voluntary refund process to implement these proposed requirements. If implemented the process would be renamed the “self-reported overpayment refund process”. This proposed process does state that the overpayment is due back to CMS the later of 60 days from identification of the overpayment, or at the due date of a corresponding cost report, if applicable. The “if applicable” was included by CMS to denote that the overpayment must be an item that is settled via the cost report, such as payments for Graduate Medical Education (GME), or the repayment is due within 60 days. If the overpayment is not refunded to CMS within the appropriate timeframe, per the proposed rule, the instance becomes a False Claims issue.

Please find the link to this proposed rule below:
http://www.gpo.gov/fdsys/pkg/FR-2012-02-16/pdf/2012-3642.pdf

Comments can be submitted 1 of 4 ways per CMS instructions.

  • Electronically at http://www.regulations.gov . Follow the “Submit a comment” instructions.
  • By regular mail. Please address comments to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6037-P, P.O. Box 8013, Baltimore, MD 21244-8013.
  • By express or overnight mail. Please address comments to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-6037-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
  • By hand or courier. Please deliver comments to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201. Comments can be left in the CMS drop slots located in the lobby of the building.

Please do not hesitate to contact one of us with any questions you may have regarding this proposed rule, or how to submit a comment to CMS.

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