Overpayments and Recoupment

Published 12/01/2016

An overpayment occurs when funds have been paid to a provider in excess of the amount due and payable by Medicare.

Overpayments are either communicated to the provider by Palmetto GBA by a demand letter, or are self-reported by the provider. To be in compliance with Medicare policies for reporting and repaying overpayments, selecting the appropriate repayment method for each situation is critical.

The CMS guidelines governing these processes can be found on the CMS website.
  • Publication 100-05 — Medicare Secondary Payer Manual
  • Publication 100-06 — Medicare Financial Management Manual, Chapters 3, 4, 5, and 12
Things to Consider When Determining Payment Method
  • Use the appropriate form
  • Timeliness of when payment must be made
  • Benefits of submitting payment by eCheck using Palmetto GBA’s eServices

Form and Payment Submission
Are the overpayment MSP or non-MSP related? Has a demand letter been issued, or is the overpayment being voluntarily sent in to Palmetto GBA? The answers to these questions will determine which form, if necessary, should be completed and sent.

For your convenience, payment and contact/address information (where to send form) are included on each applicable form. Palmetto GBA strongly recommends using Palmetto GBA’s eServices portal whenever possible. Providers can electronically submit payments and other requests along with PDF attachments online. For more information, please review the Financial Tools section in the eServices User Manual (PDF).

Palmetto GBA is committed to helping providers understand the options available to them when an overpayment situation occurs. For more information and the options available to you, please select the link below that best fits your situation.

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