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New law allows Medicare 5 years to recoup overpayments

February 3, 2013

The U.S. Centers for Medicare & Medicaid Services (CMS) will now have up to five years to recoup Medicare overpayments resulting from coding mistakes or other claims errors, according to the AOA Advocacy Group.

A 2012 report found the previous three-year recoupment limit prevented the CMS from collecting more than $300 million dollars annually. Based on its report, the Office of Inspector General (OIG) at the U.S. Department of Health & Human Services (HHS) recommended the increase.

“This additional authority granted to the CMS underscores the need for ODs to properly code, document and bill for Medicare services,” said Charles B. Brownlow, O.D., AOAExcel medical records consultant.

The increase in the statute of limitations for recovery of non-fraudulent Medicare overpayments was part of the American Taxpayer Relief Act of 2012 – signed into law by President Obama Jan. 2 and commonly known as the “fiscal cliff” legislation – which also extended existing income tax rates for many Americans and delayed planned cuts in numerous federal programs.

Official budget scoring in the legislation projects the extension will now allow the CMS to recover a potential additional $500 million each year.

The estimated $500 million serves to offset some of the cost of fixing the Medicare physician payment cut in the legislation, and most of the money will come from facilities that treat Medicare beneficiaries.

AOA coding resources

The AOA and its AOAExcel™ subsidiary offer a range of resources to assist optometrists in properly reporting services and filing claims, including “Codes for Optometry” (the only coding manual developed specifically for optometry), the AOA Coding Today website (https://aoacodingtoday. com), free online coding webinars, and the Ask the Coding Experts service that allows AOA member optometrists to request personalized advice on coding issues by email (Askthecodingexperts@excelod.com).

For a complete list, see www.aoa.org/x15181.xml.

To assist optometric office staff in avoiding common coding and claim-filing errors, the Council on Paraoptometric Certification now offers Paraoptometric Coding Certification (www.aoa.org/x17560.xml).

2 comments

  1. RAC’s have 3 years and will that be altered by rule. Will the time be even longer in the next couple of years. You can always show that millions more could be recovered by adding more years. Coding and ICD-10 especially will make the environment even more challenging.


  2. Great resources from colleagues.



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