The Centers for Medicare & Medicaid Services on Feb. 12 clarified its rules on Medicare overpayment repayment.
Prior to this clarification, under President Barack Obama's healthcare law, care providers were required to repay extra reimbursements received through Medicare within 60 days of identifying instances overpayment. If providers failed to submit repayment within this window, they faced serious penalties, including fines and exclusion from federal healthcare programs.
However, medical imaging groups and others foresaw complications stemming from this tough policy, reported Imaging Biz. Once care providers identify billing errors, they must perform internal audits to see exactly how much money they owe, a process that, in many cases, takes longer than the allotted two months. Industry experts argued that, under this stringent timeline, providers attempting to comply with federal law could receive undue penalties.
The rule received further attention in 2014 when the Department of Justice sued Mount Sinai Health System for failing return Medicare overpayments within the 60-day window, reported Becker's Hospital Review. This past August, the health system urged U.S. District Judge Edgardo Ramos to dismiss the case but the jurist held fast. Soon after, the two parties initiated settlement talks.
The attorneys representing the Mount Sinai Health System joined in with the chorus of healthcare providers protesting the regulation, reported Modern Healthcare.
"It just leaves everything open to interpretation, and sort of the luck of the draw of who you draw as a prosecutor," Erin Duffy, a partner at the law firm Duane Morris, told Modern Healthcare. "At the moment I would be nervous until the CMS really issues the rules and clarifies this issue."
In response to these concerns, CMS, in a recent posting on the Federal Register, ruled that the 60-day clock would begin once an exact overpayment amount is determined. This final ruling goes into effect March 14, 2016.
Ronny Bachrach
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