What do I do if I have been overpaid on a claim(s)?

What do I do if I receive an overpayment letter?

What happens when a Redetermination or Reconsideration appeal is requested?

What if the entire overpayment amount cannot be refunded at one time?

A. Once an overpayment has been determined, providers are required to repay the debt. Complete the Overpayment Refund form and attach a check for the amount or request an immediate offset of future payments. Specific information such as patient name, health insurance claim number and Medicare claim number must be included.

A. An overpayment letter is a formal request to repay a debt owed to the Medicare Trust Fund. Payment is due upon receipt of the notice. Send the payment with a copy of the overpayment letter received. Interest will accrue 30 days from the date on the overpayment letter and every thirty days thereafter. On day 40, we will immediately begin offsetting and claim payments will be withheld and applied until the entire debt is collected.

A. After notice of a valid appeal request, if limitation of recoupment (Section 935 of the Medicare Modernization Act) provisions apply, all collection activities are ceased, including the withholding of future claim payments. Interest, however, will continue to accrue during the appeal process.

For specific details, refer to MLN Matters article MM6183, revised September 12, 2008

A. An Extended Repayment Schedule (ERS) can be requested if the debt cannot be paid in full provider is unable to return the entire payment. An ERS request can be made by completing the instructions and returning specific documentation for either a sole proprietor or corporation/group. In order to stop any withholdings from occurring while your request is being reviewed, a first payment as scheduled by your amortization schedule will need to accompany your documentation. If no payment is submitted, we will begin withholding your payments at 30% until the review is complete.