Under the Affordable Care Act, any health care provider that identifies an overpayment from Medicare or Medicaid has a legal requirement to return the overpayment. The Act requires that the overpayments must be reported and returned by the later of 60 days after the date identified or the date any corresponding cost report is due. This has left providers confused about what is meant by identifying an overpayment and how far back providers should “look back” when investigating possible overpayments. In 2016, CMS published final regulations clarifying how Medicare Part A and Part B providers are expected to audit for and fully investigate potential overpayments.
This webinar will cover the essential elements of the final regulation for Medicare providers such as: how to define when an overpayment is identified; what CMS expects regarding agency reasonable diligence; defining the lookback period; and, how overpayments should be reported and returned. The webinar will also touch on penalties and the appeals process as related to overpayments. The webinar will also discuss how the ACA provision affects payments from other federal health care programs such as Medicaid.
Presenters: Matthew W. Wolfe, JD, Partner atParker Poe Adams & Bernstein and Jamie Lesnett, JD, Partner at Parker Poe Adams & Bernstein
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