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Top Tips for Handling Medicare Overpayments

Top Tips for Handling Medicare Overpayments

Getting payments from Medicare is the goal of all those claims you submit for patient services. But when Medicare overpays, because of an incorrect claim or any number of reasons, then the unwelcome task of sending money back to Medicare becomes top priority. But how do you go about refunding money to Medicare? Here are a few tips for Part B providers in Indiana and Michigan who use Medicare administrative contractor (MAC) WPS-GHA.

If You Find the Overpayment

If you or your staff detects an overpayment from Medicare, you can report it either electronically, through the eRefunds or Overpayment Claim Adjustment (OCA) features in the WPS-GHA portal, or by mail, using the Overpayment Notification/Refund Form.

You can submit a refund check when you send in the Overpayment Notification/Refund Form. However, if you do not send in a check, or if you report the overpayment through the portal, WPS-GHA will recoup the money for future claims.

According to Medicare, providers must report and return self-identified overpayments to Medicare within 60 days of overpayment identification and within six years from overpayment receipt, generally referred to as the “lookback period.”

If Medicare Finds the Overpayment

If your MAC identifies the overpayment (which they do for amounts over $25), they will initiate overpayment recovery by sending a demand letter requesting repayment. You can reply using the Immediate Recoupment Request Form, request immediate recoupment via the eRefunds or Overpayment Claim Adjustment (OCA) features in the WPS-GHA portal, or wait for Medicare to implement their standard recoupment process.

According to Medicare, the immediate recoupment process happens as soon as they receive your request. The standard recoupment process begins on Day 41 after they identify an overpayment, since providers have up to Day 40 to send in a payment. Regardless of how, if the overpayment has not been refunded on Day 30, interest will accrue until the refund is received.

There are two other options for how to respond to a demand letter from Medicare: You can submit either a rebuttal or an appeal. Rebuttals should be made by Day 15 after the MAC identifies an overpayment using the Overpayment Inquiry Form. Rebuttals often involve a problem or change with a Medicare Secondary Payer. Appeals should be made by Day 120 following the overpayment using the Redetermination of an Overpayment Request Form. There are five levels of appeals, and providers start with the first level, which is a redetermination of the overpayment.

Your rebuttal and appeal rights will be clearly listed on the demand letter.

Use the Portal and/or the Correct Forms

WPS-GHA encourages providers to use the eRefunds or Overpayment Claim Adjustment (OCA) features in the WPS GHA portal to avoid delays in reporting overpayments and refunds. 

“These tools allow our Payment Recovery unit to process overpayments and refunds quickly and efficiently while avoiding the usual delays that come with mailing or faxing paper forms,” the MAC said in a recent email to providers.

In addition, WPS-GHA asks providers to be careful when choosing which form to use if the portal isn’t available or they prefer to work through the mail or fax. 

“Using these forms incorrectly will result in delays in processing the overpayment or refund request,” WPS-GHA said.

Apparently, some providers attempt to report overpayments using the Immediate Recoupment or Overpayment Inquiry forms. To notify WPS GHA of an overpayment or to initiate a refund, providers should complete the Overpayment Notification/Refund Form. This is the only form providers should use to report an overpayment to WPS GHA.

Here’s a handy chart to help you stay clear on what form to use and when:

FormWhen to Use It
Overpayment Notification/ Refund FormNotify Medicare of an Overpayment You Identified and/or Send in a Refund
Demand LetterMedicare Will Send One to You When They Identify an Overpayment
Immediate Recoupment Request FormRequest an Immediate Recoupment after You Receive a Demand Letter
Overpayment Inquiry FormSubmit a Rebuttal after You Receive a Demand Letter
Redetermination of an Overpayment Request FormSubmit an Appeal after You Receive a Demand Letter

For more information about identifying, reporting, repaying, and appealing overpayments to Medicare, check out the WPS-GHA article “How to Avoid Overpayment Processing Delays.” You can also review the Medicare Overpayments Fact Sheet. For links to the most up-to-date forms for WPS-GHA, check out their Medicare Forms page.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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