The California Medical Association (CMA), along with the American Medical Association and other medical associations, sent a letter to Centers for Medicare & Medicaid Services (CMS) Acting Administrator Marilyn B. Tavener on April 16, commenting on the proposed rule to implement provisions of section 6402(a) of the Affordable Care Act. The rule will require physicians receiving Medicare and Medicaid funds to report and return overpayments.
The proposed rule is important because it clarifies when and how an overpayment must be returned. If published as currently drafted, the rule would subject physicians to a 10-year "look back" period.
“We are adamantly opposed to the proposed 10-year look back period,” the joint letter said. “Even absent a perpetual duty to identify overpayments, CMS’ proposal could require physicians to comb through 10 years of files to conduct a reasonable inquiry regarding whether an overpayment exists.” The letter suggests that the rule should remain consistent with other CMS overpayment initiatives and provide for a three-year look back period.
Other changes to the rule suggested by the organizations include a request that CMS create a clear process of appeal for physicians if a third-party auditor discovers an overpayment, and the inclusion of a uniform overpayment reporting form.
Currently, overpayments are reported to a Medicare contractor using a form that each contractor makes available on its website. These forms differ with each contractor.
To read the letter, click here.
Contact: Elizabeth McNeil, (415) 310-2877 or emcneil@cmanet.org.