CMS News

 

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that requires Medicare Parts A and B health care providers and suppliers to report and return overpayments by the later of the date that is 60 days after the date an overpayment was identified, or the due date of any corresponding cost report, if applicable.

 

The requirements in this rule are meant to support compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against improper payments, including fraudulent payment.  This rule clarifies requirements for the reporting and returning of self-identified overpayments.  Health care providers and suppliers have been and will remain subject to the statutory requirements found in section 1128J(d) of the Social Security Act (the Act) and could face potential False Claims Act (FCA) liability, Civil Monetary Penalties Law (CMPL) liability, and exclusion from federal health care programs for failure to report and return an overpayment. 

 

Section 6402(a) of the Affordable Care Act established a new section 1128J(d) of the Act.  Section 1128J(d)(1) of the Act requires a person who has received an overpayment to report and return the overpayment to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and to notify the Secretary, state, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment.  Section 1128J(d)(2) of the Act requires that an overpayment be reported and returned by the later of: (A) the date which is 60 days after the date on which the overpayment was identified; or (B) the date any corresponding cost report is due, if applicable

 

This final rule states that a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment.  Creating this standard for identification provides needed clarity and consistency for health care providers and suppliers regarding the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments.

 

Under this final rule, overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received.  Specifying the length and other parameters of the look back period provides additional clarity for providers and suppliers who have identified an overpayment that is covered by the provisions of 1128J(d).

 

This final rule provides that providers and suppliers must use an applicable claims adjustment, credit balance, self-reported refund, or another appropriate process to satisfy the obligation to report and return overpayments.  This approach for returning overpayments provides an array of familiar options from which providers and suppliers can select.

 

 This rule also provides that if a health care provider or supplier has reported a self-identified overpayment to either the Self-Referral Disclosure Protocol managed by CMS or the Self-Disclosure Protocol managed by the Office of the Inspector General (OIG), the provider or supplier is considered to be in compliance with the provisions of this rule as long as they are actively engaged in the respective protocol.

 

Apply for Hardship Exemption to Avoid Meaningful Use Penalties

(Info from the AMA)

 

Physicians have until March 15 to apply for a hardship exemption from the electronic health record (EHR) meaningful use financial penalties for the 2015 program year. Those who don't apply could face up to a 3% cut in their Medicare payments in 2017 since the meaningful use program operates on a two-year look-back period. New this year for physicians, individuals can apply on behalf of a group of physicians.

 

The Centers for Medicare & Medicaid Services (CMS) has stated that it will broadly grant hardship exemptions as a result of the delayed publication of the Stage 2 meaningful use modifications rule, which left physicians with insufficient time to report under the modified program requirements issued in late 2015.

 

All physicians should apply for the exemption since there isn't a downside to doing so. Even physicians who believe they met the requirements of the meaningful use program in 2015 can apply. Submitting an application for a hardship exemption will not prevent those who qualify from receiving an incentive payment.

 

How to apply: Physicians should be sure to submit their applications before midnight Eastern Time on March 15, 2016. Physicians can download an application from CMS.

 

While CMS has given a deadline for applications, it has not yet indicated when physicians will receive confirmation of their exemption status.

 

 

Submission of a hardship exception application does not prevent a provider from attesting and receiving an incentive payment if meaningful use requirements are met.

 

Attestation for the 2015 EHR reporting periods is currently open. The AMA urges providers to try to attest by the March 11, 2016 attestation deadline. If they successfully attest, they will avoid the payment adjustment in 2017 and may also be eligible to receive an EHR Incentive payment.

 

However, if a provider cannot attest for a 2015 reporting period or believes their attestation may be unsuccessful, the provider can apply for a hardship exception to avoid the payment adjustment in 2017. The application will not prevent a provider from earning an incentive if their attestation is in fact successful. The deadline to submit a hardship exception application is March 15, 2016 for eligible professionals and April 1, 2016 for eligible hospitals.