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Long-awaited CMS rule on overpayments gives 6-year lookback, specifies overcoding

by: Roy Edroso Feb 11, 2016

Four years after the proposed rule was issued, CMS has issued the final 60-day overpayment rule, formally called Reporting and Returning of Overpayments. It reduces the look-back period within which the agency can act on determinations that providers have received too much in Medicare funds but sets rigorous standards for determining what an overpayment is – including “over-coded” E/M claims.

Expect Medicare secondary payer overpayment demands

by: Grant Huang Aug 26, 2011

You can expect to see overpayment demands from CMS between now and November for Part B claims processed after April 1, 2011, the agency says. On April 1, CMS implemented a change request (CR 7026) that allowed its Common Working File to accept both Medicare as secondary payer (MSP) data and non-MSP data in claims adjustment lines. In English: Any patient who hasn't met the Medicare deductible, but has Medicare as the secondary payer, was issued coverage and had services paid as if the deductible were met, for claims processed anytime after April 1, 2011, CMS says.

MACs taking over RAC overpayments

by: Grant Huang Aug 9, 2011

You can look forward to overpayment demand letters -- based on audits by your recovery audit contractor (RAC) -- coming from your Medicare Administrative Contractor (MAC) or carrier, starting Jan. 1, 2012. Your MAC or carrier will now issue the demand letters, but everything else about the recoupment process will stay the same, including the 40-day discussion period and the appeals process.

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