CMS Proposes 10-Year Claims Review
Proposed rule would implement aggressive enforcement of Affordable Care Act provision that could pose problematic to providers.
- By David Kopf
- Mar 08, 2012
The Centers for Medicare and Medicaid Services proposed a rule in the Federal Register on Feb. 16 that would call for a 10-year review period for various claims, including those for home medical equipment.
The proposed rule, which is published in detail at http://www.gpo.gov/fdsys/pkg/FR-2012-02-16/pdf/2012-3642.pdf, is a response to part of the Patient Protection and Affordable Care Act, which calls for stronger policing of overpayments. So the CMS rule proposes a far-ranging, 10-year "lookback" window to hunt for overpayments that would be recouped.
"We selected 10 years because this is the outer limit of the False Claims Act statute of limitations," the proposed rule's text reads. "We believe that the proposed 10-year lookback period is appropriate for several reasons. First, we believe that providers and suppliers should have certainty after a reasonable period that they can close their books and not have ongoing liability associated with an overpayment. We also believe that the length of the lookback period is long enough to sufficiently further our interest in ensuring that overpayments are timely returned to the Medicare Trust Funds."
However, the length of the window, and other aspects of the propsed rule could prove problematic for providers. HME Business sat down with Wayne Stanfield, president and CEO of the National Association of Independent Medical Equipment Suppliers, to clarify the proposed rule's implications:
Q: What do you expect will be the implication for providers?
A: Having to maintain records for 10 years is a big problem. Currently seven years is the standard. With rules changing and software evolving, a 10-year look back will cause suppliers to refund legitimate payments without evidence to prove them right.
Q: Looking at section one under Definitions (called “overpayments”) the definition appears very broad. What is your take?
A: "Overpayments," by the CMS definition, covers a lot of territory, thus adding to the risk of suppliers being seen a committing fraud, waste and abuse.
Q: What should providers being saying in their public comments regarding this proposed rule?
A: I think comments should follow those of other providers caught in this, like hospitals and physicians. Looking back beyond four years is unreasonable, and places an unnecessary administrative burden on everyone.
Q: What else should providers be doing in regard to this proposed rule (i.e., should they be contacting lawmakers, or anything else)?
A: I absolutely think this should be a topic raised with lawmakers. CMS has 10 years under the False Claims Act, so this goes too far and will penalize suppliers.
Providers can leave comments on the rule. The deadline for public comments 5 p.m. Eastern Time, April 16, and providers can submit their questions via:
- Visiting http://www.regulations.gov and following the ‘‘Submit a comment’’ instructions.
- Mailing written comments to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–6037–P, P.O. Box 8013, Baltimore, MD 21244–8013.
- By express or overnight mail at Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–6037–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.
- By hand courier, the details for which are published in the proposed rule.
David Kopf is the Editor of HME Business.