Rules for Refunding Duplicate or Overpayments to Medicare

Our whitepaper, "Rules for Refunding Duplicate or Overpayments to Medicare", highlights:

• What to do if the primary payment exceeds the deductible and coinsurance amounts
• How to refund a primary payment from both Medicare and a primary plan
• The MSP Regulation at 42 CFR 489.20
• What form to use to report credit balances resulting from MSP payments
• If an MSP credit balance occurs late in a reporting quarter

Check out our resources page for the following document: Rules for Refunding Duplicate or Overpayments to Medicare as well as for common billing and coding questions and facts. 

The Medicare Overpayment Collection Process

Need guidelines on The Medicare Overpayment Collection Process?

The Centers for Medicare and Medicaid Services (CMS) produced a short fact sheet on "The Medicare Overpayment Collection Process" in July 2011.

According to the CMS, The definition of a Medicare Physician or Supplier Overpayment is:

"A payment that a physician or supplier has received in excess of amounts due and payable under Medicare statute and regulations. Once a determination of an overpayment has been made, the amount of the overpayment becomes a debt owed by the debtor to the Federal government. Federal law requires the Centers for Medicare & Medicaid Services (CMS) to seek the recovery of all identified overpayments."

In Medicare, physician or supplier overpayments occur due to: 

• Duplicate submission of the same service or claim;
• Payment to the incorrect payee;
• Payment for excluded or medically unnecessary services; or
• A pattern of furnishing and billing for excessive or non-covered services.

The Overpayment Collection Process

• Demand Letters
• Repayment Plans
• Rebuttals
• Appeals

Additionally there are links to external websites regarding Medicare Overpayments and the collection process.

To download and view the full fact sheet, please go to the following link: The Medicare Overpayment Collection Process Fact Sheet