CMS announced it will be looking to ease the reporting burdens for participants in the meaningful use incentive programs beginning this year with a proposed rule change in the spring. CMS indicates the new rule would address issues raised by participants such as “software implementation, [and] information exchange readiness.” Some of the potential changes under review include: >moving hospitals to a calendar year reporting period, giving them more time to adjust to new software and “align with other CMS quality programs”; >changes to the incentive programs that will reduce reporting obligations and complexity; > reduce the 2015 reporting period to 90 days in light of these potential changes. Note that CMS emphasized these proposed changes are separate from the Stage 3 proposed rule that should be released in March and will address meaningful use requirements for 2017 and beyond. Takeaway: Pathologists were among the physician specialties granted exemption from payment reductions in 2015 that will be imposed for failure to satisfy meaningful use requirements. This further easing of burdens in the meaningful use initiative is a positive sign regarding CMS’s willingness to acknowledge the realities and difficulties of complying with these requirements. CMS Delays Final Rule on Overpayments The Affordable […]
CMS announced it will be looking to ease the reporting burdens for participants in the meaningful use incentive programs beginning this year with a proposed rule change in the spring. CMS indicates the new rule would address issues raised by participants such as “software implementation, [and] information exchange readiness.”
Some of the potential changes under review include:
>moving hospitals to a calendar year reporting period, giving them more time to adjust to new software and “align with other CMS quality programs”;
>changes to the incentive programs that will reduce reporting obligations and complexity;
> reduce the 2015 reporting period to 90 days in light of these potential changes.
Note that CMS emphasized these proposed changes are separate from the Stage 3 proposed rule that should be released in March and will address meaningful use requirements for 2017 and beyond.
Takeaway: Pathologists were among the physician specialties granted exemption from payment reductions in 2015 that will be imposed for failure to satisfy meaningful use requirements. This further easing of burdens in the meaningful use initiative is a positive sign regarding CMS’s willingness to acknowledge the realities and difficulties of complying with these requirements.
CMS Delays Final Rule on Overpayments
The Affordable Care Act requires providers to report and return overpayments and provide a reason for the overpayment within 60 days after discovering the overpayment or the due date for a related cost report, whichever occurs last. Failure to do so risks false claims liability. CMS published a proposed rule implementing this requirement in February 2012 and has yet to finalize that rule. Citing “significant policy and operational issues that need to be resolved” and a need to coordinate with other government agencies, CMS is extending the deadline for finalizing that rule by one year until Feb. 16, 2016.
However, that doesn’t alleviate laboratories’ and other providers’ obligations to report and return overpayments promptly. It merely means there isn’t a specific framework developed for these reports. CMS indicates it must collaborate with the DOJ and OIG in developing these regulatory requirements.
“Further delay is extremely frustrating for clinical laboratories and other providers which are required to report and return an overpayment within 60 days of its identification, but have not been provided any real guidance as to when an overpayment is considered to have been identified,” says health care attorney Robert E. Mazer, of Ober Kaler in Maryland. “On the other hand,” he adds, “the government may be hampered in relying on grounds provided for under the proposed rule that may go beyond what the law requires. Many believe, for example, that the statute does not permit penalties to be imposed for failure to make a ‘reasonable inquiry’—‘with all deliberate speed’—after receipt of information about a possible overpayment, as the proposed rule requires.”
Takeaway: It’s encouraging that CMS is taking time to consider operational issues and hopefully provide specific regulation that can clearly indicate how the overpayment requirements will be enforced; however, the delay creates uncertainties for those trying to comply and avoid the risk of false claims liability.
