PAI Comments on CMS Proposed Overpayment Rule

This week, the Physicians Advocacy Institute (PAI), Inc., an affiliate of the NCMS, sent a letter on behalf of more than 100 professional medical associations to the Centers for Medicare and Medicaid Services (CMS) Acting Administrator Marilyn Travenner reporting their concerns about the “Returning and Reporting of Overpayments” proposed rule made effective in February 2012. Read the letter here

In the letter, PAI highlights several aspects of the rule that CMS should clarify, including:

  • Physicians should not be obligated to proactively search for an overpayment unless there is reason to believe a specific overpayment exists;
  • CMS should finalize a policy that the 60-day reporting period begins on the day that an error-specific overpayment inquiry has ended as to not cause confusion with numerous reporting days;
  • PAI strongly opposes the proposed 10-year look back period and to remain consistent, CMS should implement a three-year look back period;
  • CMS should limit the reach of the overpayment obligation to no earlier than the passage of the Patient Protection and Affordable Care Act (ACA) on March 23, 2010;
  • If a physician has received an overpayment determination from a CMS auditor, the processes and appeals rights of that overpayment audit program should be controlled to avoid confusion and duplication of payment, and physicians should be exempt from obligations under the ACA related to that overpayment;
  • Physicians should be able to administratively appeal an overpayment determination;
  • CMS should omit the proposed reporting requirements pertaining to overpayment reports since the reason behind overpayment reporting is currently not a requirement;
  • To avoid confusion, the proposed standard reporting form should be released with CMS’ final rule on this matter. The form should also include a section for physicians to note their disagreement with the audit findings; and
  • CMS should reconsider the estimated cost of implementing the proposed rule.

The NCMS will continue to monitor this issue closely. Refer to upcoming Bulletin articles for updates.


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