Deadlines Proposed to Report, Return Overpayments
March 9, 2012
National Intelligence Report
Rob Mazer comments on CMS’ proposed rule directing Medicare Part A and Part B providers and suppliers to report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due-whichever is later. Rob discusses the implications for labs.
"Compliance with the proposed rule could be extraordinarily difficult for clinical laboratories because of the sheer number of similar tests they perform and Medicare claims that they file," said attorney Robert E. Mazer, a principal with the law firm of Ober|Kaler (Baltimore), in comments to NIR.
"If there is evidence to suggest that a lab has been overpaid for a particular test or even for tests ordered by a particular physician, the process of identifying and quantifying any overpayments could be overwhelming." Under the proposed rule, health care providers are required to make a "reasonable inquiry" when there is evidence of a possible overpayment, Mazer noted. "A lab, however, may be unable to determine whether a previously received Medicare payment was an overpayment based on its own records. The treating physician’s medical records would generally control medical necessity issues, for example. These records may be extremely difficult or impossible for a lab to obtain, particularly when tests could have been performed up to 10 years earlier. It would appear reasonable that if the lab cannot access records required to determine whether tests were not medically necessary, then it has not identified an overpayment that must be reported and repaid. The proposed rule, however is silent on this issue."
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