Top Provider Questions – Overpayment Recovery
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- What is the Overpayment Recovery Department?
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The Overpayment Recovery Department's goal is to assist you with overpayment refunds, offset, lost checks, and other overpayment issues.
Reviewed 12/13/2023
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- When would I contact Overpayment Recovery?
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You will contact Overpayment Recovery when you identify a Medicare overpayment.
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- How do I submit a request to Overpayment Recovery?
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You will use the Overpayment Refund Form to submit a voluntary refund. This will ensure we properly record and apply your check.
NOTE: If you are not sure of the overpayment amount, you may submit a request using the Overpayment Recovery Request Form without attaching a check. We will calculate the overpayment and create an Accounts Receivable for the amount due.
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- Where can I find forms for an Overpayment Refund?
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The Overpayment Refund form can be found on the Part B Forms page or you may submit your request electronically in the myCGS portal.
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- What information is needed when submitting a voluntary refund?
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Always complete the physician/refund portions and use the reason codes listed on the bottom of the Overpayment Refund Form to identify the reason for your refund. The date of service (DOS), beneficiary Medicare ID number, and the reason you are submitting a refund is also required.
- When refunding for multiple beneficiaries, please be sure to include sufficient documentation to show how much money is being refunded for each claim.
- We recommend that you refund no more than 20 beneficiaries per check.
- We recommend that you not combine voluntary refunds with MSP involvement and voluntary refunds for NMSP in the same request.
- We recommend that you not combine voluntary refunds with demand check refunds.
NOTE: If your check involves MSP, please refer to the MSP FAQ for additional information.
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- Who is this offset for?
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You may obtain this information by calling in to our Interactive Voice Response (IVR) at 1-866-290-4036. Select option 3 for financial information and option 4 for offset information.
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- Who is this special check for?
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Please contact our Customer Service Department.
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- How do I request an offset when I have received a refund request from Medicare?
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You may submit an Immediate Offset Request Form.
Immediate offset(s) may also be requested by submitting an e-Offset Request through myCGS web portal.
Please NOTE: Interest may still be assessed even if this form is received within the 20 day time frame.
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- I faxed in an offset request. Has it been offset yet?
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If you have your Accounts Receivable number you may obtain this information by calling in to our Interactive Voice Response (IVR) at 1-866-290-4036. Select option 3 for financial information and option 4 for offset information.
If you do not have your Accounts Receivable number, please contact our Customer Service Department.
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- Why are you recouping?
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The answer to this question varies. However, you may see the reason for denial on your Medicare Remittance Advice. Please refer to your Medicare Remittance Advice and review the denial reason code. An explanation of this reason code can be found on the last page of your Medicare Remittance Advice.
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- Can you send me a stop payment form?
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The Stop Payment Affidavit form is available at https://cgsmedicare.com/hhh/financial/forms/stop_payment_affidavit.pdf, and is located from the Forms icon under the Overpayments & Refunds topic on the left side navigation menu.
NOTE: A stop payment cannot be processed until the check has been outstanding for 30 days.
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- Why did you send me money back?
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The answer to this question varies. Common reasons for refunded funds include but are not limited to the following: you have submitted excess funds for the overpayment; you have stated that Medicare is the primary payer when the claim was originally submitted as a secondary payment, we are refunding interest, you have sent funds to us in error.
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- Where was my check applied?
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Please contact our Customer Service Department.
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- I sent in a check and you offset. How will I get my money
back?
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In this scenario, you have sent in a payment to satisfy an Accounts Receivable listed in a demand letter sent to you. However, the demand has offset before the check is processed.
- If you have an open Accounts Receivable, we will send a letter to your office to inform you of where the money will be returned (the remittance notice it will be applied to.)
- If you have no open Accounts Receivables, we will send the funds back to you.
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- Did you receive my check?
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Please contact our Customer Service Department.
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- I have a Medicare Remittance Advice (RA) that shows this money
was already offset. Why did you offset twice?
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The answer to this question varies.
- Please notice that when a claim is adjusted, the original claim and the adjusted claim are shown on the RA. The original claim is shown with a negative sign in front of the paid amount. This "negative amount" is in fact only there for informational purposes. That amount has not been offset.
- Do you see a forwarding balance (FB) on your RA? Please note, this forwarding balance does not represent an offset.
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- How can I tell by looking at my Medicare Remittance Advice
(RA) that there has been an offset?
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You can determine if funds have been offset by looking for the "FCN/AR" (Financial Control Number/Accounts Receivable) number with a "WO" (offset) beside it at the end of the RA.
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- Why am I not receiving payment?
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The answer to this question varies. Please contact our Customer Service Department.
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- I need to update my address you are sending information to.
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Please visit the Provider Enrollment section of this site or contact our Provider Enrollment Department by calling 1-866-276-9558.
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- When do I submit a Reopening request instead of an overpayment
request?
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You will submit a reopening request when you need to make a minor correction to a previously submitted claim if there is no overpayment. You will submit an overpayment request when you have identified an overpayment by Medicare.
Reference - The Reopening versus Redetermination Job Aid
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- How can I stay up-to-date on any change in procedure?
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To stay informed of any updates on all Medicare information, please join our CGS electronic mailing list.
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- What information is needed when submitting an extrapolated refund?
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A CGS statistician reviews for acceptability all voluntary refunds based on statistical sampling. In order for the statistician to replicate the sampling and validate the refund amount, with each refund check submission, providers must send CGS the details of the sampling and extrapolation performed to estimate the overpayment. The following is a listing of the information that must accompany any voluntary refund submitted that is based on statistical sampling for overpayment estimation. Note that the overpayment amount to be refunded is at the discretion of the MAC in coordination with CMS. Use of a methodology that yields the following elements is required and supersedes any methodologies that may have been approved by audit firms, statistical consultants, or the Office of Inspector General (OIG).
- Description of the Review Population (universe)—including an explanation of the methodology used to develop the population and the basis for this determination. [Provide any criteria that would warrant exclusion from the population. For example, claims for which the original payment was $0.]
- Electronic spreadsheet of the Sampling Frame—List the sampling frame, which is the totality of the sampling units from which the sample was selected. [The frame must be sorted in a way that is replicable (by Claim Number, for example) prior to random selection and the unique sort order identified even if the frame is serially enumerated to aid in matching to randomly generated numbers. CGS must receive the entire listing even if claims of other government or private payers were included in the universe. This is allowable under TPO of HIPAA, as it is required for validation.]
- Sample Size—Indicate how an estimate of the size for the sample was conducted. If RAT-STATS was used, provide the RAT-STATS output. [The Point Estimate (i.e., average overpayment of sample X # of units in the universe) is the best estimate of the overpayment and is the required refund for self-audits based on sampling. Providers should attain whatever level of precision will allow them confidence in submitting the point estimate amount as the refund. Stratification by paid amount is often used to lower the number of sampling units needed to achieve a desired level of precision. Stratification by HCPCS or CPT code will not aid you in this respect and should be avoided. Stratification by year should also be avoided unless separate analyses per year are needed for cost report purposes. Use of a certainty stratum for a few universe claims that are much higher in payment than the rest can also reduce sample size when estimating using paid amounts as surrogates for overpayment amounts.]
- Random Numbers—Either provide the RAT-STATS or other random number generator output in electronic format or indicate the seed number so that the generation of the random numbers can be replicated and applied against the frame to obtain the sample. Indicate the source of the seed number. [Note that the RAND() function in Excel is not sufficient as it does not provide a seed number that can be used to reproduce the random numbers for validation. The use of random tables within statistical texts on sampling is acceptable as long as the title, author, page number(s), and seed number are provided.]
- An electronic listing of the claims in the sample with the results of the review for each – Provide the overpayment for each item in the sample. [If the sampling unit is a claim with services per claim line, provide the overpayment per line prior to totaling per claim even if the overpayment is $0. Voluntary refunding providers are not allowed to net out underpayments. Please confirm this was not done. If possible, indicate the amount Medicare paid and amount that should have been paid for each item.]
- Estimation Methodology—The RAT-STATS results or if RAT-STATS was not used for the extrapolation, provide the formulas used to obtain the results along with the calculations. Be sure to include the resulting point estimate, standard error, and precision percent of your data as well as your level of confidence in the resulting point estimate. [When calculating precision, note that that the lower bound of the one-sided 90% confidence interval is equal to the lower bound of the two-sided 80% confidence interval. Still, as indicated previously, the Point Estimate of the confidence interval, not the lower bound, is the required refund for self-audits based on sampling.]
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