MPFS Proposed Rule Includes Potential Changes to Regulations for Reporting Medicare Overpayments

The July proposed rule of the Medicare Physician Fee Schedule (MPFS) includes a proposal to change the Medicare overpayment policy. In response to comments received from the December 2022 proposed changes, the Centers for Medicare and Medicaid Services (CMS) has revised the proposal further to provide greater clarification of the responsibilities and timeline involved with reporting overpayment. 

The Affordable Care Act (ACA) included reporting requirements for Medicare overpayments. The statute requires the reporting, return, and reason for the overpayment by 60 days from when the overpayment is identified. The statute further defines “identified” to be that someone “has, or should have through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount.” The 2022 proposed changes from CMS would remove the “reasonable diligence” and amend this definition to specify that the provider “knowingly receives or retains an overpayment,” using the definition of “knowingly” from the False Claims Act (FCA).

The current CMS proposal retains the 2022 proposed changes and adds more changes open to public comment. In brief, the additional changes stipulate that the 60-day reporting and return requirement could be suspended if a provider is investigating if any related overpayments exist, or could arise from a similar case. If such an investigation is being conducted, the provider could report and return the overpayments within 60 days of identification of the completion of an investigation, or 180 days from the date the overpayment is identified, whichever is the earliest date. Some analyses of the proposed rule suggest that ambiguity may still remain about the timeline and if any repayments will be needed during investigations.

CMS is accepting comments on the calendar year 2025 MPFS proposed rule until September 9, 2024. As reported previously by the Academy, the MPFS includes cuts in payments to all providers including audiology (see audiology code payment tables).