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Overpayment Refund

Medicare Financial Management Manual (CMS Pub. 100-06), Ch 5 §410External PDF
MLN Matters Article MM3274 Unsolicited/Voluntary RefundsExternal PDF

Providers typically make refunds to overpayments by submitting adjustment bills, but they occasionally submit refunds via check. When you identify a Medicare overpayment, and choose to submit a voluntary refund, complete the Overpayment Refund FormPDF. This Form should be included with every voluntary refund to ensure the check is properly applied. The submission of such a refund related to Medicare claims in no way 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 those or any other claims.

For assistance in completing this form, refer to “Helpful Tips” section below. This will ensure we properly record and apply your check.

Helpful Tips

  • Include the patient’s first and last name, as well as their Health Insurance Claim (HIC) number.
  • Include the Document Control Number (DCN) of the processed claim for which you are submitting the refund. This can be found on your remittance advice (RA) or by reviewing the Fiscal Intermediary Standard System (FISS) screen, MAP171D (refer to Chapter 3 of the FISS GuidePDF).
  • Include any additional information needed to correctly adjudicate the claim, such as revenue code line information, treatment authorization code (home health only), charges, etc. The list below provides a summary of the information frequently required to accurately process a home health or hospice voluntary refund.
    • Type of bill on the claim, such as 329 or 813, etc.
    • FROM and TO date on the claim
    • Revenue code, HCPC code, units, charges and service date for each revenue code line
  • Complete the provider portions
  • Indicate the appropriate reason code(s) listed on the bottom of the form to identify the reason for your refund.
  • When the refund applies to multiple beneficiaries, include sufficient documentation showing how much money is being refunded for each claim.
  • Send separate checks for overpayments previously requested (demand letters) from those that are being voluntarily refunded.
  • Send separate checks for beneficiaries being refunded due to Medicare Secondary Payer (MSP) from those being refunded due to Non-MSP.
  • When refunding due to MSP, please be sure to include the primary insurance's explanation of benefits. This is needed in order to determine the correct primary insurance allowed and paid amounts.

Mail your check and the Overpayment Refund Form as instructed below. Please address to "MSP Overpayment Recovery" if for MSP.

Mailing address for refund checks (include a cover letter stating the check is being remitted for a voluntary refund):

CGS – J15 Home Health & Hospice
PO Box 957124
St. Louis, MO 63195-7352

Mailing Address for the Voluntary Overpayment Refund Form and other supporting documentation (include a copy of the check remitted to the St. Louis PO Box address):

CGS – J15 HHH Correspondence
Attn: Voluntary Refunds
PO Box 20014
Nashville, TN 37202

Posted: 08.30.13

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