How The 60-Day Repayment Rule Will Impact You

On Feb, 12, 2016, CMS issued its final rule implementing the Affordable Care Act (ACA) requirement that providers and suppliers report and repay overpayments from Medicare, known as the "60-Day Rule."  The ACA requires a person who has received an overpayment to report and return the overpayment by the later of  (a) 60 days after the date the overpayment was identified; or (b) the date any corresponding cost report is due, if applicable.  Notably, the final rule imposes a look-back period of six years, a shorter time period than the ten year period set forth in a proposed version of the rule previously circulated by CMS. 

Providers and suppliers can face potential False Claims Act liability, civil monetary penalties, and exclusion from federal healthcare programs for failure to report and return overpayments.  Due to the self-reporting aspect of the rule, medical practices will need to be proactive in developing compliance plans and infrastructure to comply with the final rule.  In addition, because of the six-year look-back period, medical practices should consider revising their corporate documents as they relate to retiring physicians and other physicians who leave the practice contributing to overpayment refunds for the period when they were in the practice.

Here are some questions you may be asking yourself:

When does the 60- day period begin?

The 60-day period begins when a provider identifies an overpayment.  A person has "identified" an overpayment when such 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.  Providers will generally have six months from the receipt of "credible information" to investigate possible overpayments before the 60-day clock starts running.