'Look back' time eased for final Medicare overpayment rule

The rule requires providers to return overpayments within 60 days of identification.
The rule requires providers to return overpayments within 60 days of identification.

Providers are getting some relief from the final 60-day Medicare overpayment rule issued by the Centers for Medicare & Medicaid Services on Thursday.

The rule, mandated as part of the Affordable Care Act, requires Medicare Part A and B providers and suppliers to return overpayments within 60 days of identifying them. The original proposed rule also included a 10-year “look back” period that would have put providers on the hook for a decade worth of unreported and uncollected overpayments.

That look back period, which caused provider alarm and disappointment among experts, has been dropped down to six years in the final rule. The new time frame will address stakeholder concerns without creating “additional burden or cost” for providers, CMS said.

Some healthcare providers are still disappointed with the look back period, saying it should be dropped to three years and not put “providers in a position of having to spend too much time looking back for inadvertent errors,” Mark Silberman, a partner at Duane Morris; Chicago office told Modern Healthcare.

CMS estimates the annual cost of reporting and returning overpayments for the healthcare industry as a whole to be between $120 million and $200 million. The agency did not say how much it expects to recover.