Just when you may have thought you were getting a handle on this RAC thing, here comes a new regulation that may get some people excited.  I am referring to the 60 day deadline recently imposed by the new healthcare reform law entitled the Patient Protection and Affordable Care Act of 2010 (PPACA).

Cutting through the mumbo-jumbo, this act imposes a requirement that providers must report and refund any overpayment within 60 days from the date it is identified.   Failure to comply is a violation of the False Claims Act (FCA), and exposes the provider to severe consequences.

A Useful Legal Opinion

The 60 day deadline was addressed recently by attorneys David Glaser and Katherine Burkhart from the Fredrickson & Byron law firm (www.fredlaw.com).   In an online article entitled New Medicare/Medicaid Refunding Requirement: Report and Return Within 60 Days of “Identification”, they rendered the following legal opinion:

“The new law features two key words: “overpayment” and “identified.” Many legal commentators suggest that under the new law [providers] must report and return an overpayment with 60 days of the first indication that an overpayment exists. We strongly disagree. We believe that until you have (1) absolutely concluded that there is an overpayment and (2) ascertained the amount of the overpayment, the overpayment has not been “identified.” As long as you move expeditiously toward quantifying the overpayment, the 60-day time period applies AFTER the size of the overpayment is determined.”

Conclusion

Their conclusion is that until Health and Human Services (HHS) issues clarification, this will remain “one of those proverbial gray areas” that providers must deal with.  Speaking for myself, if I were a provider, I’d give myself the benefit of the doubt on this one!

Winston Creath is an independent healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics.  He serves as President of National Business Solutions of GA, LLC.  He can be reached at winston@nbsoga.com for questions or comments.

About

Winston Creath is an independent executive healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics. He serves as President of National Business Solutions of GA, LLC. He can be reached at winston@nbsoga.com for questions or comments.

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