The final rule relaxes the requirements on “identification” and look-back period.

The Centers for Medicare & Medicaid Services (CMS) has released its long-awaited final rule related to the reporting and refunding of Medicare Part A and Part B overpayments (60 Day Rule).

Finalized nearly six years after the enactment of the Affordable Care Act (ACA), the final rule clarifies that an overpayment is “identified” when a provider or supplier “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.” CMS notes that this standard should provide needed clarity and consistency for the application of the 60 Day Rule. Providing some expected and welcome relief, the final 60 Day Rule also provides for a look-back period of 6 years instead of the 10 years CMS had initially put forward in its 2012 proposed rulemaking. 

The 60 Day Rule will go into effect 30 days after its publication in the Federal Register, which is expected on February 12, 2016. Medicare providers and suppliers should remember that the obligation to report and refund identified Medicare overpayments has been required by the statute since the ACA’s enactment in 2010.