Around the end of February of this year, I started receiving a higher-than-normal rate of requests for my sampling and extrapolation services. Providers wanted me to create a statistically valid random sample of some set of claims and then conduct a four-year retroactive extrapolation with the results.
While I have done this type of work in the past, most of the time I am defending providers against sampling and extrapolation errors committed by government and private payers; this felt like “opposite day.” At the time, I wasn’t really aware of what is now called the Final 60-day Payback Rule, which the Centers for Medicare & Medicaid Services (CMS) released on Feb. 12 before it went into effect on March 13.
In general, the rule indicates that once you discover or have reliable information that an overpayment has occurred, you have 60 days to pay the money back to the government. I thought that was pretty much it, and likely would have continued thinking so, were it not for all of the extrapolation requests. CMS puts it this way: “Under this final rule, overpayments must be reported and returned only if a person identifies the overpayment within six years of the date the overpayment was received. Specifying the length and other parameters of the lookback period provides additional clarity for providers and suppliers who have identified an overpayment that is covered by the provisions of 1128J(d).”