CMS Delays Final Ruling on Medicare Overpayments – What Could It Mean for Your RCM Payment Program?

In 2012, Centers for Medicare and Medicaid Services (CMS) published a rule that would require providers to report and refund any overpayments within 60 days from the date the overpayment was found.  As an orthopedic provider, you have probably received some of these notices from Medicare.  However, due to the amount of comments and extensive discussion around the issue, CMS has delayed its final ruling on the 60-Day Overpayment policy.  Of particular concern has been the provision that this requirement could include audits going back as much as ten years.  So what does this mean for your office?  Read on.

You’re still responsible for overpayments.

Even without a final rule for the 60-Day policy, CMS was clear in reminding the public that providers will continue to be held accountable for reporting and returning overpayments.  This requirement comes from Section 1128J(d)(2) of the Affordable Care Act, and is still in effect as CMS prepares its decision regarding the 60-day time period for repayments.  In fact, failure to comply with Section 1128J(d)(2) could lead to serious consequences, such as:

• Liability under the False Claims Act
• Liability under the Civil Monetary Penalties Law
• Exclusion from Federal health programs.

It’s important that you make yourself aware of everything written in the Affordable Care Act regarding reimbursement of overpayments, in order to avoid repercussions that could negatively affect your practice.

You may have longer than 60 days to return payments.

While you will certainly be held responsible for reporting overpayments, you may not be subject to the 60-day timeline.  That being said, you should take care of any refunds as soon as possible to avoid confusion.  What’s more, be sure to call and seek answers for any refund requests with which you disagree.  After all, CMS is not error-proof; there are instances when a payment was correct to begin with, but someone makes a mistake and sends out a request for reimbursement.

Additionally, take the time to make sure all your ducks are in a row.  Medical notes, coding, and anything else that affects your billing, should be precise and accurate.  This should reduce the number of refund requests you receive, and may help you dispute those you find incorrect.

Help is available.

With CMS publishing and then delaying rules, it can be complicated keeping up with the policies you’re required to follow.  At Health Information Services, we help you wade through the swamp of unclear legalities so that you can sleep easily at night, knowing you’re in compliance and not in danger of suffering damaging consequences. To learn more about managing the finances of your orthopedic practice, contact us today.