In April, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which repealed and replaced the controversial Sustainable Growth Rate (SGR) formula.  A lesser known, but nevertheless important, provision of MACRA requires Medicare Administrative Contractors (MACs) to establish an “improper payment outreach and education program.”  Specifically, Section 505 of MACRA requires each MAC to establish a program under which the MAC will give providers certain information, with priority placed on activities that will reduce improper payments in certain areas.

In connection with these new education and outreach activities, HHS will give each MAC a list of the types of improper payments identified by Recovery Audit Contractors (RACs) with respect to providers and suppliers located in the MAC’s jurisdiction.  Pursuant to this program, RACs will provide the MACs with various information, including, but not limited to, a list of providers and suppliers that have the highest rates of improper payments, items and services furnished in the region that have the highest rates of improper payments, and items and services furnished in the region that are responsible for the greatest total dollar amount of improper payments.

The outreach, education, training and assistance programs provided by MACRA are to be conducted on a regular basis and, therefore, physicians and their practices should pay close attention to any communications received from their MAC and promptly take any corrective action indicated.  Where the MAC flags a reimbursement, billing, or coding issue in a report to a provider, the government would likely argue that the report has “identified” any resulting overpayment that might exist.  In light of the Affordable Care Act’s 60-day rule (which requires providers to report and return any overpayment it receives within 60 days of identifying such overpayment or risk liability under the False Claims Act), it is crucial to address any issue raised by a MAC or any other government entity without delay.

For more information, or if we can assist you in an overpayment or other reimbursement issue, please contact attorney Scott Grubman at (404) 262-6505 or