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May 1, 2023

Total Invoice Price and Overpayments

Total invoice price is the net amount of provider pays for an item in service, considering ALL discounts, rebates, refunds, or other adjustments. In the circumstances that the total invoice amount is paid, and the provider subsequently receives payment from a third party, such as a volume-based discount, rebate, refund, or other adjustments this is considered "overpayment". The provider is obligated to report and voluntarily refund the overpaid amount.

According to section 1128J(d) of the Social Security Act, a provider must report and return a self-identified overpayment to its Medicare Administrative Contractor (MAC) within:

  • 60 days of identifying the overpayment
  • 6 years from getting an overpayment, generally known as the "lookback period"
  • A corresponding cost report due date, if applicable

Overpayments can be submitted via a fax with a form or electronically in myCGS portal.

Directions for return of an overpayment are available on the CGS website at: Overpayment Reopenings

Top Provider questions regarding Overpayment Recovery are answered at: Top Provider Questions – Overpayment Recovery

Resources

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