At the end of 2022, CMS proposed an amendment to its overpayment regulations to revise the definition of several terms, including the "identified" definition, specifying when a provider has "knowingly received or retained an overpayment."
Two years later, CMS has not finalized the proposals set forth in the proposed rule with respect to Medicare overpayments under Parts A and B, but it plans to make changes in the 2024 proposed rule, according to an Aug. 23 article in the National Law Review.
In the 2022 proposals, which are still under CMS consideration, the agency proposed further changes to the deadline for reporting and returning overpayments and clarified certain circumstances that will extend the deadline for a provider who has identified an overpayment.
The 2024 proposed rule would add a new deadline that gives providers up to 180 days to investigate whether there are the "same or similar" overpayments.
If the conditions are satisfied, the deadline for reporting and returning the initially identified overpayment and related overpayments that arise from the same or similar cause or reason would remain suspended until either the investigation of related overpayments concludes and the aggregate amount of the initially identified overpayments and related overpayments is calculated, or until 180 days after the date on which the initial identified overpayment was made.
The updates are in response to feedback received from the 2022 changes, according to the article.
The 2024 proposed rule is intended to tackle concerns over when an overpayment is deemed to have been "identified" in light of the removal of the quantification standard in the 2022 proposed rule and the lack of clarity on having a reasonable period of time to conduct investigations into potential overpayments.
The 2024 proposed rule could also contain a stricter timeline for conducting and completing investigations into potential overpayments, the article said.