Monday, August 1, 2016

Here is Another Reason for Healthcare Stress

In a recent Healio article they discuss the duty of physicians to identify CMS over-payment mistakes and to then contact CMS and make restitution all within 60 days. They state:

Have you ever heard someone in your office say, “I think Medicare may not have paid these claims correctly?” After that statement, did the relevant documents get buried in a pile on a desk — never to be reviewed again? Be careful. Earlier this year, CMS issued a final rule governing the responsibility of providers to report and return Medicare overpayments. The rule makes clear that providers are responsible for identifying and repaying overpayments that may have occurred within a 6-year lookback period, and repayment must be made to Medicare within 60 days of identifying the overpayment. Failure to take action could trigger liability under the “reverse” false claims provisions of the federal False Claims Act, which punish the retention of federal dollars paid in excess of the actual amount to which the provider was entitled....The rule applies to overpayments arising within Medicare Parts A and B, and it requires any Medicare provider or supplier that has identified an overpayment to report and return the overpayment within 60 days after the date on which the overpayment was identified. Somewhat helpfully, the final rule recognizes that providers cannot meaningfully “identify” an overpayment without also confirming and quantifying the overpayment; consequently, under the rule, “a person has identified an overpayment when the person 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.”

Now on top of EHR management, paperwork, the new CMS payment scheme, you have to become the auditor for CMS as well as their working capital manager.

One should wonder how many such traps there are out there today. Physicians will all end up as employees and getting salaries, working 40 hour weeks, and ultimately getting paid accordingly. There will be no more Oslers, Cushings, Kaplans and the like.