Medicare Overpayment

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On February 12, 2016, the Centers for Medicare and Medicaid Services issued a Final Rule that specifies the time frame for reporting and returning overpayments.  A new Section 1128J(d)(1) of the Affordable Care Act requires a person who has received an overpayment under parts A or B of the Medicare program to report and return the overpayment to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and to notify the Secretary, state, intermediary, carrier or contractor to whom the overpayment was returned in writing of the reason for the overpayment.

Overpayment is defined as:

any funds that a person has received or retained under title XVIII of the Act to which the person, after applicable reconciliation, is not entitled under such title.”

The Rule states that providers receiving funds under the programs must return overpayments by the later of:

  • 60 days after the date on which the overpayment was identified; or
  • the date any corresponding cost report is due, if applicable.

The Final Rule is effective March 14, 2016. Please refer to the April issue of the American Practice Advisor for more information.

Disclosure Requests for Legal Proceedings

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Disclosure of protected health information (PHI) for use in legal proceedings is permitted under certain circumstances.  If a covered entity receives a court order that is signed by a judge, requesting PHI, it should comply with the order and provide the information that is specifically requested.

If the practice receives a subpoena, discovery request, or other lawful process that is not accompanied by a signed order of the court, certain satisfactory assurances must be obtained from the requesting party prior to disclosure of the requested information.

In these instances, the requesting party must provide the practice with either of the following:

  • Satisfactory assurances that reasonable efforts have been made to give the individual (whose information has been requested) notice of the request; or
  • Satisfactory assurances that the party seeking such information has made reasonable efforts to secure a qualified protective order (see below) that will guard the confidentiality of the information.

Please refer to the article, Requests for Disclosure of PHI for Legal Proceedings, in the April issue of the Advisor®, for more information regarding satisfactory assurances and documentation requirements.