Medicare wants their money back. At least that’s what their “60-day rule” regulations say, and the increase in lawsuits they are filing against practices just like yours to get it.
Lack of compliance with these regulations can lead to you being fined up to $11,000 for each improper payment you received and didn’t return (going back up to 6 years). This affects all Medicare and Medicaid providers (outpatient practices, hospitals, clinics, home health agencies, etc.)
Medicare auditors identified incorrect claims payments for 2017 of approximately $41.08 BILLION. With this kind of money on the table, Medicare has a pretty big incentive to aggressively go after these funds – and you.
Although the underlying requirements to comply with the “60-day rule” seem straightforward (i.e., overpayments are to be refunded to Medicare within 60 days), complying with them is anything but. That’s where healthcare attorney, Heidi Kocher, BS, MBA, JD, CHC, can help.
During a 60-minute, down and dirty online training session, Heidi will tell you exactly what you have to do to comply so you can avoid a billing fraud charge and hefty fines. Here are just a few of the questions that you’ll get answered by viewing Heidi’s session:
- When does the 60-day clock actually start ticking?
- Who should you report identified overpayments to?
- What are the specific documentation requirements regarding any alleged overpayments?
- What should be included in your repayment protocols?
- When is an overpayment considered “identified”?
- What specific action should you take if you receive a carrier overpayment notification?
- What is the best way to calculate a repayment amount?
- When can you stop the clock on the repayment 60-day deadline?
- What are the acceptable methods for issuing repayments – check, electronic, etc.?
- How can you appeal a recoupment notification?
- And so much more…
You should know that the government plans to vigorously enforce the 60-day overpayment rule. In fact, they’ve already taken legal action (Kane v. Healthfirst, Inc. et. al). The government is suing for $11,000 for each of the 900 overpayments identified by a whistleblower ($9.9 million). And the court has ruled that because the facility had been informed of the overpayments and didn’t take action quickly enough they are liable.
Who should attend? This session is essential for physicians, medical group administrators or managers, hospitals, clinics, long term care facilities, health care consultants, etc. Basically, anyone who receives payments from Medicare or Medicaid.
Since this rule went into effect, numerous practices have been hit with massive non-compliance penalties. Sign up for this must-attend session today to ensure your refund protocol is adequate to protect you from fraud allegations and massive fines. Register today.
Although it sounds simple, figuring out what the deadline is for refunding overpayments can be as much art as science. Don’t leave your compliance to chance. This session attempts to remove some of the mystery when making repayments so that you can avoid both legal and financial headaches.
Heidi has 20 years of experience in health care legal and compliance related issues. Her experience includes positions at a large hospital corporation, serving as a compliance officer for a sleep lab/DME company and a compliance director, chief privacy officer and interim chief compliance officer at a medical device manufacturer.
In addition, she has represented and advised critical access and long-term care hospitals, physician groups, home health agencies, DME companies, pharmacies (including compounding pharmacies), non-profit organizations, and licensed individuals. As a result, she understands the complexities and challenges that providers large and small face in complying with increasingly varied and complex laws.
She is an expert in all aspects of compliance and privacy programs, including developing and deploying policies, procedures and training. Her experience includes implementing the various requirements and aspects of a Corporate Integrity Agreement, responding to and defending audits from Medicare, Medicaid and private insurers up through the ALJ level, guiding clients through voluntary self-disclosures, seeking advisory opinions from the OIG, and defending FDA audits.
Heidi developed criteria for and implemented an aggregate spend system, permitting a medical device manufacturer to timely report correct information under the Physician Open Payments Acts (also known as the Physician Payments Sunshine Act).
In addition, she is experienced in developing and implementing a compliance program to address Foreign Corrupt Practices Act requirements, including Eucomed guidelines. She also has significant reimbursement experience, addressing coverage policy issues, challenging denials, recoupments, and loss of billing privileges, obtaining HCPCS codes, and other reimbursement related issues.