New CMS 60-Day Rule Revisions: Key Changes Impacting Reporting and Return of Medicare/Medicaid Overpayments

Description

CMS recently issued a final rule, effective Jan. 1, 2025, updating and clarifying requirements for reporting and returning Medicare and Medicaid overpayments to address concerns raised since the regulations implementing the 60-day rule were published in 2016.

One of the key revisions amends the standard for determining when an overpayment has been identified, as derived from the False Claim Act, to initiate the obligation to report and return funds. Formerly, an overpayment was identified when the provider, through the exercise of reasonable diligence, determined it had received an overpayment and quantified the amount. Under the new rule, an overpayment is identified when an entity or individual "knowingly" receives or retains an overpayment by having actual knowledge of the overpayment or acting in deliberate ignorance or reckless disregard of the overpayment. Under the new rule, the 60-day clock to refund the overpayment starts as soon as an overpayment has been identified, regardless of whether it has been quantified.

Another key update allows for suspension of the 60-day return period for 180 days for the purpose of conducting a timely, good faith investigation to determine the existence of related overpayments that may arise from the same or similar cause as the initially identified overpayment.

Counsel should understand the new rule's requirements to guide clients through its application to processes and procedures and to mitigate risk of noncompliance.

Listen as our expert panel provides a comprehensive overview of the CMS updates to the 60-day rule governing the reporting and return of Medicare and Medicaid overpayments. The panel will discuss the impact on healthcare providers and suppliers and offer best practices for compliance.