CMS Proposes 10-Year Review for Provider Overpayments

John Commins, March 2, 2012

A proposed rule that would extend responsibility for Medicare overpayments through a 10-year "lookback period" is generating concern from healthcare providers. 

The proposed rule, posted in the Federal Registry on Feb. 16 by the Centers for Medicare and Medicaid Services, implements a provision of the Affordable Care Act that details reporting and reimbursement guidelines for Medicare overpayments.

The lookback period now is generally about four years. CMS estimates that extending the review by another six years would cost as much as $58 million in reporting-related expenses each year for about 125,000 providers and suppliers.

The public comment period on the proposed rule extends through April 16.  

Amy E. Nordeng, government affairs counsel for the Medical Group Management Association, told HealthLeaders Media that a 10-year lookback would create an undue burden for most healthcare providers.

 "We wish it was shorter. We are going to argue that it should be shorter," said Nordeng. "For a group practice finding the records and having the same billing system in place 10 years down the road is pretty unlikely."

"Four years is much more reasonable because practices are used to that. You plan for the government being able to go back four years so you are able to develop processes for that," she says.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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