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Finalization of the Proposed 60-Day Overpayment Rule Delayed by CMS

Finalization of the Proposed 60-Day Overpayment Rule Delayed by CMS

Health Care Law Note
(February 25, 2015)

February 20, 2015 marked the three-year deadline for finalizing the 60-Day Overpayment Rule proposed by CMS on February 20, 2012. Citing difficulties in defining a number of the objective standards in the proposed rule, CMS announced in the February 12, 2015 Federal Register that it would take another year to consider the issues before finalizing the rule.

Sec. 6402(a) of the Affordable Care Act (ACA), passed in 2010, requires the return of Medicaid and Medicare overpayments the later of 60 days from when the overpayments are discovered or from the date the related cost report is due. Although Sec. 6402(a) became effective upon passage of the ACA, CMS proposed a rule in 2012 to frame the obligations of the provider in discovering overpayments. Defining "reasonable inquiry," and defining those individuals that could be tasked with "knowledge" sufficient to trigger the start of the 60-day time frame are just a couple of the challenges CMS is struggling with in putting structure to the subjective terms in the proposed rule. CMS reports that it needs the additional time to come up with clear requirements. The new date is February 16, 2016.

Even though Sec. 6402(a) is still the law, CMS's struggle with its own final rule illustrates how difficult it is to practically implement the law. Thus, without clear guidance from CMS, providers should develop their own reasonable guidelines designed to discover, investigate, and report overpayments. These guidelines should define the subjective terms in the law in a way that is meaningful to the provider and which balance reasonable investigation with timely reimbursement of overpayments.

Lisa Kaminski Shortt
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