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Overpayment and Recoupment

Topic Brief Description

Extended Repayment Schedule (ERS)

Providers may need longer than 30 days to repay the full amount of an overpayment. Providers have the option to submit a Request For Extended Repayment Schedule (ERS) Form. When this has been determined, the request for ERS must be submitted immediately and completely.

Medicare Secondary Payer (MSP) Overpayments

In order for Medicare to demand an overpayment after a MSP (Medicare Secondary Payer) claim has paid, the MSP Part B Form must be submitted along with the primary insurer EOBs.

Overpayment Interest Rates

View overpayment interest rates for the last five years. The interest rate applies to overpayment debts over 30 days old.

Request 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. The provider will need to have currently processed and paid claims to cover the overpayment amounts prior to the 30th day, so interest will not accrue.

Respond to a Demand Letter

When Medicare has determined that an overpayment exists, a receivable account will be established and a Demand Letter will be issued. It is critical for timely payment in order to avoid interest from accruing. The provider is given 30 days from the date of the Demand Letter to pay the requested overpayment amount. If payment is not received timely, interest will accrue.

Submit a Voluntary Refund

A voluntary refund is when an overpayment has been self-identified. A check is required to be submitted along with the appropriate form. The check will be applied to the identified overpayments. If there are excess funds, they will be applied per Change Request 3274.

 

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

Overpayment Types

  1. Non MSP Overpayments
  2. MSP Overpayments

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

Consider When Determining Payment Method

  • Appropriate form to use
  • Timeliness of when payment must be made

Form and Payment Submission

Is the overpayment MSP or 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.

For provider convenience, payment and contact/address information (where to send form) is included on each applicable form.

Last Updated Jun 15, 2016