CMS Releases Medicare Reporting and Returning of Self-Identified Overpayments Final Rule

Today, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Program; Reporting and Returning of Overpayments Final Rule, which 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 rule provides clarification on the meaning of an overpayment identification, the required lookback period for overpayment identification, and the methods available for reporting and returning identified overpayments. 

Clarification of “Identification”
Specifically, the rule states that an overpayment must be reported and returned by the later of: (i) the date which is 60 days after the date on which the overpayment was identified; or (ii) 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.

Lookback Period
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.

Reporting and Returning Overpayments
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. 

ASCRS and Alliance of Specialty Medicine Advocacy
This rule finalizes proposals originally released in 2012. At that time, the ASCRS signed on to comments with the Alliance of Specialty Medicine requesting CMS to clarify its definition of identification and to shorten the originally proposed lookback period of ten years to three. The Alliance contended that Medicare typically only requires fee-for-service providers to retain documents for six years.

ASCRS will continue to monitor this issue and keep you updated. If you have additional questions, please contact Ashley McGlone, manager of regulatory affairs, at or 703-591-2220.