Barring unforeseen further delay CMS will publish its Final Rule for the “60-Day Rule.” Under the 60-Day Rule any providers who receive overpayments under either Medicare Part A or Part B will have 60 days from the date the overpayment was identified to report and refund the overpayment. Failure to report and refund an overpayment may result in False Claims Act liability, Civil Monetary Penalties Law liability, and exclusion from Federal health care programs.
Whether you are the CEO of a major health care system, an individual hospital or clinic, it is critical to be aware of the parameters of the 60-Day Rule and to have a mechanism in place to detect and report and refund any Medicare overpayment. Once the 60-Day Rule is finalized it is critical to fully evaluate and understand the nuances of that rule, particularly any “look-back” provision of the final rule. In addition to fully understanding the parameters of the final rule, the best providers will evaluate all internal overpayment policies and procedures and make sure that those policies are consistent with the requirements of the final rule. The best way to mitigate your risks under the 60-Day Rule is to have a proactive compliance and audit program in place and to update to programs in a manner consistent with the final rule for this important Medicare payment provision.
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