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February 16, 2016
Medicare Shortens Lookback Period for Returning Overpayments
In a final regulation published February 11, the Centers for Medicare & Medicaid Services (CMS) shortened the retrospective period that it can quickly collect overpayments discovered by physicians, who are now responsible for reporting and returning Medicare overpayments going back six years.
The CMS initially proposed in 2012 a 10-year lookback requirement, but physician associations including the CAP, stated such a timeframe would be too excessive. In 2012, the CAP joined the American Medical Association (AMA) and other specialty societies to adamantly oppose the 10-year lookback period. The physician organizations recommended a three-year lookback period would be less burdensome. As a result, the CMS reduced the retrospective period to six years by stating: "overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received."
The final rule requires Medicare overpayments for hospital and physician services to be returned with 60 days of the discovery of an excess payment.
"This final rule states that a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment," the CMS stated in a summary of the rule. "Creating this standard for identification provides needed clarity and consistency for health care providers and suppliers regarding the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments."
Reporting Medicare Overpayments
This final rule provides that providers and suppliers must use an applicable claims adjustment, credit balance, self reported refund, or another appropriate process to satisfy the obligation to report and return overpayments. This approach for returning overpayments provides an array of familiar options from which providers and suppliers can select.
This rule also states that if a healthcare provider or supplier has reported a self-identified overpayment through a process called the Self-Referral Disclosure Protocol managed by the CMS, or the Self-Disclosure Protocol managed by the Office of the Inspector General (OIG), the provider or supplier is considered to be in compliance with the provisions of the final rule as long as they are actively engaged in the respective protocol.
Speaker Added to 2016 Policy Meeting: The Tarrance Group's Ed Goeas
Joining the lineup of political, policy, and pathology leaders at the 2016 CAP Policy Meeting is expert political researcher and strategist Ed Goeas. Register today to hear from Mr. Goeas and other experts at the 2016 Policy Meeting in Washington, DC May 2–4.
Ed Goeas is the President and CEO of The Tarrance Group, one of the most respected and successful Republican survey research and strategy teams in American politics today. Widely recognized as one of the country's leading political strategists, Goeas is an often sought after consultant. In the 2010 election cycle, The Tarrance Group elected six new Governors (and now has six as clients), and four U.S. Senators, with Goeas playing a key role in the winning campaigns of Governor John Kasich, Governor Mary Fallin, and Senator John Boozman.
Attend the 2016 Policy Meeting to hear from political experts like Goeas and take action to advocate on behalf of the pathology specialty. On May 4, pathologists will meet with their senators and representatives in Congress during the CAP's annual Hill Day.
Collaborate. Advocate. Take Action.
Join your colleagues at the 2016 CAP Policy Meeting May 2-4, 2016 in Washington, DC. Focus on the issues most important to pathologists now and in the future. The CAP's Annual Hill Day will take place on May 4.
White House Proposes Funds for Cancer 'Moonshot,' Precision Medicine Initiatives
President Obama's budget for fiscal year 2017 proposes $755 million increase to accelerate research in diagnosing and treating cancer and $300 million to continue work on 2015's Precision Medicine Initiative.
The president's budget will largely fall flat in Congress because lawmakers passed a comprehensive budget for 2016 and 2017. Additionally, Congress passed an omnibus appropriations bill to fund the government in fiscal year 2016. Appropriations for 2017 will be guided by the comprehensive budget and, therefore, President Obama's last budget is more symbolic than substantive.
During the 2016 State of the Union Address, President Obama announced the new "moonshot" initiative to eliminate cancer. The increase in funding is in addition to the National Institutes of Health's (NIH's) significant investment for the cancer moonshot in 2016. The budget's multi-year cancer initiative, which begins in 2016, provides $680 million to NIH and $75 million to the Food and Drug Administration (FDA) in 2017, to improve health and outcomes for patients through investments in research and infrastructure, and brings together researchers across sectors and scientific disciplines. Notably, these funds would significantly increase support for research to help realize the promise of cancer immunotherapy. Similar to the President's Precision Medicine Initiative, a key component in the proposed research will use diagnostics and traditional pathology methods.
The CAP continues to engage with federal agencies on precision medicine and related initiatives to improve health and treat disease.
Precision Medicine Initiative
The 2017 budget also includes $300 million for NIH to continue the progress of the President's Precision Medicine Initiative. The budget supports efforts underway to establish a voluntary national research cohort of one million or more Americans, expand research to define cancer subtypes and identify new therapeutic targets, modernize the regulatory framework for DNA-sequence-based diagnostic tests, and improve health data sharing and interoperability so patients can access their health records for research, providers can recommend optimal treatments and researchers can use individual and population data to develop new insights and therapies.
Funding also supports activities to engage patients, including those from historically underserved communities, and raise awareness about the promise of precision medicine for all. A key component of this initiative will use diagnostics and traditional pathology methods to drive research and thus a new regulatory paradigm to approve therapeutics and devices.