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July 17, 2012

Submitting Refunds to Medicare: Overpayments

The Overpayment Recovery department of CGS was established to assist you with overpayment refunds, offsets, lost checks, and other overpayment issues.

If you determine that your office or practice received an overpayment from Medicare, we ask that you either:

  • Submit an Overpayment Refund Form to explain the reason for the overpayment (if you know the amount Medicare overpaid, you may also submit a check made payable to "Medicare"), or
  • Request an immediate offset of the overpayment by submitting an Immediate Offset Form.

Overpayment Refund Form

Use the Overpayment Refund FormPDFto submit a voluntary refund (please do not use this form if CGS has already requested repayment via a "demand letter"). This will ensure we properly record and apply your check. Also, if you are not sure of the overpayment amount, you may submit a request using the Overpayment Refund Form without attaching a check. We will calculate the overpayment and create an Accounts Receivable for the amount due.

Some other helpful tips when sending refunds to Medicare:

  • Always complete the physician/refund portions and use the reason codes listed on the bottom of the form to identify the reason for your refund.
  • The date of service (DOS), beneficiary's Health Insurance Claim Number (HIC #), and the reason you are submitting a refund are required.
  • When refunding for multiple beneficiaries, please be sure to include sufficient documentation for each patient to show how much money is being refunded for each claim.
  • We recommend that you refund no more than 20 Internal Claim Numbers (ICNs, also called CCNs) per request.
  • When sending in multiple checks, please attach documentation for each check. We have identified instances in which there is only one piece of documentation attached to the first check. The checks are processed separately; this results in development for the remaining checks, potentially causing a delay in processing.
  • Send separate checks for overpayments previously requested (demand letters) from those that are being voluntarily refunded.
  • If the claim is over one year old, please include the CGS Medicare Remittance Advice with your form.
  • Send separate checks for beneficiaries being refunded due to Medicare Secondary Payer (MSP) issues from those being refunded due to reasons other than MSP.
  • When refunding due to MSP, please be sure to include the primary insurer's explanation of benefits. This is needed in order to determine the correct primary insurance allowed and paid amounts.

Immediate Offset Request Form

If you would like to have the overpayment immediately offset the overpayment from your next check from Medicare, simply complete the Immediate Offset Request FormPDF. The request may be submitted via regular mail or fax, and the request must include documentation on the overpayment to be offset.

The specific request on the Immediate Offset Request Form may be for:

  • A one-time request for a specific demanded overpayment (the total amount of the demanded overpayment); or
  • A permanent request for the specific demanded overpayment and all future demanded overpayments. (Note: if your office or practice already has an immediate offset agreement in place, any new requests must be submitted to CGS in writing. The old agreement will remain in effect until we receive and process a new form from you.)

By choosing immediate recoupment, you are waiving your right to interest under Section 935 of the Medicare Modernization Act (MMA) in the event that the overpayment is reversed at the Administrative Law Judge (ALJ) or subsequent higher levels of appeal.

Other helpful tips:

  • You may terminate the immediate recoupment process at any time. The request to terminate must be in writing. If the full amount of the debt is not recouped within the first 30 days the debt will accrue interest, and CGS will follow normal collection processes. Immediate offsets will only occur on provider numbers that are still receiving payments from Medicare.

For further information, please refer to:

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