Overpayments and Recoupment

Many situations may cause a supplier to owe Medicare money on previously paid claims.

  • Noridian initiated claim edit correction
  • Contractors claim reviews (Noridian, Recover Auditor, Comprehensive Error Rate Testing (CERT), Office of Inspector General (OIG), etc.)
  • Claim paid when should have denied had all beneficiary services been submitted in sequential order (e.g., Skilled Nursing Facility (SNF) or hospital admissions)
  • Changes to beneficiary's eligibility as maintained by Social Security Administration (e.g., date of death, cancelled policy, election of a Managed Care Plan)

Access the below related information from this page.

Overpayment Monetary Threshold

CMS requires the DME MAC to request refunds on overpayments of $25 or more. If a supplier owes several small overpayments, each of which is less than $25, the total amount owed will be aggregated at the end of the month. DME MACs will accept refunds of less than $25. A supplier must submit specific documentation to support the extended repayment plan request.

Overpayment Rebuttal

A supplier may submit a rebuttal when there is good cause to believe the DME MAC should not withhold claim payments to offset a recouped account receivable.

Common Reasons to Submit a Rebuttal

  • Check has been submitted for payment
  • Overpayment was created in error
  • Overpayment was created for a full, instead of a partial claim adjustment, and a clarification is included with rebuttal statement

Request Rebuttal in Writing (E.g. Business Letter or Memo)

To ensure correct processing:

  • Clearly indicate "Rebuttal" in subject line or first sentence of document and on envelope
  • Clearly state reason for rebuttal and include supporting documentation, e.g., cashed checks
  • Include a copy of original overpayment letter with rebuttal statement. If original overpayment letter is not available, include below in rebuttal
    • Supplier's name
    • National Provider Identifier (NPI) or Provider Transaction Access Number (PTAN)
    • Document Control Number (DCN)
    • Beneficiary Medicare number
    • Date of service (DOS)

Mail overpayment rebuttals to Noridian.

Rebuttal will be reviewed and a written response will be sent to the supplier.

If a supplier has a rebuttal question on a Recovery Auditor Overpayment, view the Recovery Auditor Determinations - Agree or Disagree webpage.

Voluntary Refund

A voluntary refund is a situation that causes a supplier to owe money to Medicare on a previously paid claim(s). Although Medicare may have not notified the supplier of this overpayment, a voluntary refund must be submitted.

To ensure proper recording and timely processing, submit your voluntary refund along with a check using the applicable completed "MSP Overpayment Refund Form" or "Non-MSP Voluntary Checks Refund Form" option from the Forms page. Instructional details and mailing address are included. To submit an overpayment refund request without enclosing a check, follow the instructions for submitting a Non-MSP Overpayment Refund Request.

Resources

 

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Limitation on Recoupment of Medicare Overpayments CR11808 02/22/2024