In a letter to CMS acting Administrator Marilyn Tavenner, the Alliance wrote that under the proposed 10-year "look-back period," fee-for-service providers would have to retain documents for four years longer than Medicare currently requires them to. The alliance proposed reducing the overpayment-liability period to three years.
"In the case of criminal activity and intentional fraud, the federal government has the authority to audit for longer periods of time and a 10-year look-back for this rule is unwarranted," the Alliance wrote in the letter. In its proposal, the CMS said a decade-long period was chosen because that is the outer limit of the federal False Claims Act.
The Alliance also states that the CMS does not clearly define when a 60-day repayment window would open. The letter argues that the window should start at the conclusion of a review confirming overpayment and not on the first day a potential overpayment is brought to the attention of a provider. "For those physicians who use external billing services," according to the letter, "there may be considerable lag between requesting necessary documents and receiving and analyzing them."
The American Hospital Association and the Federation of American Hospitals have also criticized the proposed rule as unreasonable.
About 200,000 physicians are represented by the Alliance, which consists of the American Academy of Facial Plastic and Reconstructive Surgery, the American Association of Neurological Surgeons, the American Gastroenterological Association, the American Society of Cataract and Refractive Surgery, the American Society of Plastic Surgeons, the American Urological Association, the Coalition of State Rheumatology Organizations, the Congress of Neurological Surgeons, the Heart Rhythm Society, the North American Spine Society and the Society for Cardiovascular Angiography and Interventions.
The CMS estimated the total "burden cost" of reporting and returning overpayments at between $34.8 million and $58 million. It did so by estimating that some 125,000 providers would have between three to five overpayments that would require about $37.10 in staff hourly wages to process.