Voluntary Refund / Self-Disclosure - JE Part A
Providers who are participating in the Office of the Inspector General Self Disclosure Program should not be making a voluntary refund to the Medicare office, but should be working directly in accordance with their agreement with the OIG.
Last Updated Thu, 22 Dec 2016 09:02:39 +0000
Voluntary Refund / Self-Disclosure Process
A voluntary refund may be made to Noridian when a provider has discovered an error, which resulted in an overpayment from the Medicare Trust Fund. Voluntary refunds can be made to Noridian by provider adjusted claims or by mailing an unsolicited check.
Noridian requests that claims be adjusted by the provider whenever possible. If claims are offline Noridian may be able to reinstate claims for you to adjust. To determine if it is possible to reinstate claims you can no longer view in the system, contact the Provider Contact Center.
Benefits of Provider Adjustments:
- If a potential CERT, RAC, or PSC review were to be imposed, it will help to show the providers have made the appropriate adjustments to the claims to voluntarily refund any inappropriate money they would have been paid
- Makes certain the Common Working File (CWF) is reflecting the correct charges for the beneficiary
- Ensures the beneficiary has received the corrected Medicare Summary Notice (MSN) in case there is an adjustment to the coinsurance or deductibles owed by the beneficiary
- Ensures beneficiary utilization days and benefit periods are correctly applied for any applicable inpatient or Skilled Nursing Facility (SNF) claims
Unsolicited checks received by Medicare are deposited the same date as received. The documentation submitted by the provider with these checks is important for the assurance of the correct application of that refund. Checks for individual claims currently in the system should not be submitted, but rather a claim correction should be made.
A voluntary check form should be completed and mailed with your check and supporting documentation for the refund.
Providers need to be aware that, "The acceptance of a voluntary refund in no way affects or limits the rights of the Federal Government or any of its agencies or agents to pursue any appropriate criminal, civil, or administrative remedies arising from or relating to these or any other claims."
For further information regarding the process of voluntary refunds, see CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 4.
Last Updated Mon, 24 Feb 2020 10:55:19 +0000