60 days is not much time to report and return overpayments.
The 60-day rule allows providers 60 days from when an overpayment is “identified” to report and return the payment. Providers are permitted to take up to six months to do their “reasonable diligence” to confirm the existence and quantify an overpayment.
The 60-Day Protocol Decision Making Tool offers a step-by-step process to determine if the 60-day rule applies.
- Easy to navigate,
decision-tree format allows the user to apply and record a consistent approach to identify potential overpayments interactive
- Multiple cases can be created and tracked at the same time
- Safe, secure storage of relevant case files
- Stand-alone, web-based application, specifically tailored to the 60-day compliance process
The failure of hospitals to promptly investigate and report/return an overpayment can be costly.
The first federal lawsuit involving interpretation and application of the 60-day overpayment refund rule was settled on August 24, 2016. The government sent a powerful message when the New York Attorney General announced that Mount Sinai Health System agreed to pay $2.95 million to settle allegations that three of its hospitals held approximately $844,000 in Medicaid overpayments beyond the 60-day deadline for reporting and returning identified overpayments. The failure of the hospitals to promptly investigate and report/return the $844,000 overpayment to the Medicaid agency ultimately cost them over three times the original overpayment amount.
The 60-Day Protocol Tool helps hospitals remain compliant with the rule and avoid costly potential penalties.