Overpayment and Recoupment

An overpayment occurs when too much has been paid to a provider and a refund to Medicare is necessary.

Overpayments are either communicated to a provider via a Noridian Demand Letter or self-reported by a provider. To be in compliance with Medicare policies for reporting and repaying overpayments, selecting the appropriate payment method for each situation is critical.

Is the overpayment Medicare Secondary Payer (MSP) | Non MSP related? Has a Demand Letter issued or is the overpayment is being voluntarily sent in to Noridian? The answer to these will determine which form, if necessary, should be completed and sent.

When determining a payment method, it is important to consider which form to use and the timeliness of when payment must be made.

Accelerated Payments - View reasons a provider may request an accelerated payment as well as Provider Request for Accelerated Payment Form, Accelerated Payments Calculation, and Accelerated Payment Request Certification

Bankruptcy - Notify Noridian if you file bankruptcy. View details.

Credit Balance Reports - A credit balance exists when a facility receives an overpayment for a Medicare service. The CMS 838 Form, Excel report, and submission guidance are provided.

Extended Repayment Schedule (ERS) - Providers may need longer than 30 days to repay full amount of an overpayment. Providers have the option to submit a Request For Extended Repayment Schedule (ERS) Form. View details.

Immediate Recoupment - Medicare allows providers to sign up for Immediate Recoupment, a process which allows overpayments to be automatically recouped from currently processed and paid claims. View details.

Limitation on Recoupment - View information regarding Section 1893(f)(2)(a) of the Social Security Act, which provides limitations on the recoupment of Medicare overpayments during the appeals process.

MSP Overpayments - For Medicare to demand an overpayment after a MSP claim has paid, submit the MSP Part B Form along with primary insurer EOB. View details to avoid processing delays.

Overpayment Interest Rates - View overpayment interest rates for last five years. Interest rate applies to overpayment debts over 30 days old.

Respond to a Demand Letter - When Medicare has determined that an overpayment exists, a receivable account is established and a Demand Letter is issued. View options for satisfying overpayment.

Submit a Voluntary Refund - A voluntary refund is when an overpayment has been self-identified. There are two types of voluntary refunds, MSP and Non MSP. View submission details.


Last Updated Jun 23 , 2021

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