- Introduction
- About Provider Outreach and Education
- ABN for Not Reasonable and Necessary Denials
- Appeals/Reopenings
- Assignment of Benefits
- Comprehensive Error Rate Testing
- CMS-1500 Claim Form
- Deceased Beneficiary Claims
- Electronic Data Interchange
- Evaluation and Management Services
- Fraud and Abuse
- Health Professional Shortage Area
- Hospice
- Limiting Charge
- Medical Policy Development
- Medigap
- Modifiers
- Nonphysician Practitioners
- National Provider Identifier
- Participation Program
- Payment Floor Standards
- Provider Enrollment
- Refunds and Overpayments
- Ordering and Referring Claims Information
- Return/Reject
- Standard Remittance ANSI Codes and Remittance Advice
- Appendix 1: Forms
- Appendix 2: Glossary
- Appendix 3: Place of Service Codes
Medicare Part B 101 Manual
Refunds and Overpayments
Table of Contents
- Medicare Contractor Initiated Demand Letters
- Providers Not on Automatic Recoupments
- Provider-Initiated Non MSP Overpayments
Medicare Contractor Initiated Demand Letters
When it has been determined that a physician/supplier has been overpaid, a refund request demand letter will be sent to the physician/supplier. The initial demand letter for an overpayment includes the following information:
- Overpayment amount
- Beneficiary name
- Beneficiary MBI
- Invoice number
- Claim number
- Date of service
- Reason for the overpayment
The National Government Services Medicare demand letter will identify the services that triggered the overpayment process.
Two items in the demand letter warrant immediate attention.
- The first is the invoice number and claim number. The provider shall reference the invoice number and claim number in any communication with NGS.
- The second is the date of the demand letter. The provider has 30 days from the date of the demand letter to refund NGS. If NGS has not received the refund within this 30-day period, interest begins to accrue against the overpayment amount.
NGS has a streamlined automated process to satisfy overpayments in a cost effective way saving provider's staff time and money.
Providers on automatic recoupments do not need to respond to the demand letter. A remittance advice will follow with a “WO” for withholding.
Sign up on our website:
- Select the Resources tab, then select Overpayments
- Select Request an Immediate Recoupment, then select JK or J6 Immediate Recoupment Request Form - Electronic/E-mail
- For the Immediate Recoupment Type select Current and Future Overpayments
- Fill in the remainder of the electronic form with your provider information
- Once all boxes are populated, click Submit.
By submitting this request you acknowledge that an immediate recoupment payment arrangement constitutes a voluntary payment and you may be waiving the right to potential payment of interest pursuant to Section 1893(f)(2) for the overpayment(s).
Please note: If the form continues to display, you will need to populate the appropriate boxes or make corrections. If the form disappears, your submission was successful. Ensure that your organization does have claims being submitted and scheduled Medicare payments.
Providers Not on Automatic Recoupments
When sending a check to NGS for a demanded debt, please be sure to include a copy of the overpayment letter. In addition, be sure to send checks to the appropriate lockbox:
Jurisdiction K (CT, MA, ME, NH, NY, RI , VT)
National Government Services, Inc.
P.O. Box 809645
Chicago, IL 60680-9645
Jurisdiction 6 (IL, MN, WI)
National Government Services, Inc.
P.O. Box 809194
Chicago, IL 60680-9194
If full payment is not received by the 40th day from the date of the initial demand letter, the offset process (i.e., deducting payment from the physician/supplier’s Medicare check) will begin.
Future payments will be offset until the full overpayment amount is satisfied. The offset process is placed on hold if a Section 935, MMA eligible debt is in the appeal process.
If the offset procedure has begun and payment is subsequently received, interest will be deducted, the amount that had already been applied by offset will be deducted and the balance returned to the provider, unless there are other debts due to Medicare.
Provider-Initiated Non MSP Overpayments
All voluntary refunds should be sent to the NGS as soon as they are discovered. Providers who are registered to use NGSConnex should use this option to submit reopening requests electronically.
Revised 10/2/2023