Medicare 60-Day Repayment Rule

On February 12, 2016 the Centers for Medicare and Medicaid Services (CMS) published a final regulation regarding the 60 day repayment rule.

Final Rule highlights:

• An overpayment is any Medicare payment received or retained by the group to which it is not entitled. An erroneous payment by the Medicare contractor, through no fault of the provider, is still an overpayment.
• After the provider has identified and quantified the amount of the overpayment then the 60 day repayment clock will start running, as long as the provider exercises reasonable diligence in doing both.
• Reasonable diligence includes both proactive compliance activities designed to detect overpayments and reactive investigations designed to quantify overpayments in response to credible information.
• Investigation and repayment should be completed within eight months—six months to investigate and quantify, and 60 days to refund and report.
• Failure to exercise reasonable diligence causes the 60 day repayment clock to revert back to the date the provider received credible information.
• The obligation to refund can go back to six years.

Information obtained from: http://www.mgma.com/Libraries/Site-Images/Government%20Affairs/2015/Sub%20landing%20features/CMS-Repayment-Rule-PPSV-memo(D0650368).pdf?ext=.pdf