Overpayments and Recoupment - JA DME
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.
- Extended Repayment Schedule (ERS)
- Immediate Recoupment or Offset
- Limitation on Recoupment
- Overpayment Interest Rates
- Overpayment Monetary Threshold
- Overpayment Rebuttal
- Recovery Auditor Overpayments
- Surety Bond
- Voluntary Refund
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.
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.
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.
- CMS Internet Only Manual (IOM), Publication 100-06, Medicare Financial Management Manual, Chapter 3
- CMS IOM, Publication 100-06, Medicare Financial Management Manual, Chapter 5
- CMS Change Request (CR) 6183 - Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayments
Last Updated Thu, 02 Mar 2023 20:54:19 +0000
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.