top of page

Update: Limitation on Recoupment of Medicare Overpayments

HOME HEALTH and HOSPICE PROVIDERS


Release Date: February 15, 2024 MLN Matters Number: MM11808 (link)

Effective Date: July 1, 2024 Related Change Request (CR) Number: CR 11808 (link)


Action Needed

Make sure your staff knows about:

  • Limits on recouping of overpayments

  • When to request an extended repayment plan (ERS) or choose an immediate recoupment

  • How we pay interest on overpayments


Background

The limitations on the recoupment of Medicare overpayments are during the first and second levels of appeal only. This provides protection to providers during the initial stages of the appeal process. During this time, providers can voluntarily:


  • Request an ERS

  • Choose an immediate recoupment


If you don’t establish an ERS, MACs will resume recoupment at 100% until the debt is paid in full after the second level of appeal, regardless of any subsequent appeals you file. This includes the third level, the ALJ, or subsequent levels, or Department Appeals Board or Federal Court. Interest payments are only applicable to overpayments we recover through involuntary recoupment under the limitation on recoupment provisions. Interest isn’t payable on the principal amount recouped on voluntary payments such as payments from an existing ERS, immediate recoupment prior to the qualified independent contractor (QIC) decision, payment suspensions, and check payments.


Policy Changes

Section 1893(f)(2)(a) of the Social Security Act and a provision in the Medicare Prescription Drug, Improvement and Modernization Act of 2003:

  • Prohibits recouping Medicare overpayments from providers or suppliers seeking a reconsideration from a QIC

  • Changes how we pay interest to providers or suppliers whose overpayment is reversed at subsequent administrative or judicial levels of appeal

  • Limits recoupment of Medicare overpayments when providers or suppliers seek a redetermination until a redetermination decision is made

  • Defines the overpayments to which the limitation applies, how the limitation works in concert with the appeals process, and the change in our obligation to pay

19 views0 comments

コメント


bottom of page