Recent changes in the recovery limitations and impact on SZPIC – PSC Medicare overpayment Appeal


CMS has recently issued a Final Rule his face restrictions on the recovery of the alleged excess payments with contractors. This Final Rule finalizes (at least for now) how contractors are continuing when pursuing recovery actions. “Restore” is defined as the recovery of Medicare overpayment by reducing present or future Medicare payments and apply the amount withheld against debt.

Under the current rules, which can be recovered through either score rebuttal or appeals process. Before the passage of the Medicare Modernization Act (MMA), CMS could add overpayments, regardless of whether the provider or supplier has filed an appeal. With CMS ‘final rule in place, the restrictions placed on the ability of the contractor to conduct a recovery operation. As the Federal Register states:

“This final rule defines overpayments as limiting the recovery goes, how restriction works in partnership with the appeals process, and sets time limits for recouping overpayments, especially providing 41 days provider or supplier register first level of appeal for the contractor can start the recovery and provide provider or supplier 60 days to appeal to the second level before developers can begin recovery “(74 Fed. Reg. 47458, 47458 (September. 16, 2009)).

In particular, a Medicare contractor can freely start the recovery of the overpayment once the review decision has been rendered, regardless if the Administrative Law Judge (ALJ) appeal is lodged.

Should hand prefer to postpone recovery, the amount owed will be subject to Medicare rates. This amount varies but is generally very high. For example, as of 07/17/09, was 11.25%. As such, it is particularly important to provide the following in mind :.

(1) If overpayment decision is overturned past revision level appeals, CMS is responsible for the interest on back excess has slipped

(2) If the provider or supplier takes advantage of the limitation of recovery and eventually loses its appeal, it will still be responsible for all interest accrued from the original decision, together with the overpayment.

With so much at stake, it is important that health care providers and suppliers fully understand the nuances of overpayment appeals and restore process. By timely filing complaints or rebuttals providers can actually delay recovery but unfortunately you can not avoid it altogether. Ultimately, CMS ‘final rule will make it more important than ever to health care providers who accept overpayment review get qualified legal advice to help guide them through the process.

This article is provided as general information only. It does not constitute legal advice and should not be used instead to seek legal counsel. Readers with legal questions should call Liles Parker PLLC or consult their lawyer.


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