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How will you know if you have a Medicare overpayment?

Due to a variety of circumstances, such as clerical errors, duplicate payments or processing mistakes, recipients of Medicare can receive too much money. The Centers for Medicare & Medicaid Services requires recipients to return any excess funds within 60 days, or the organization will take further action. 

To avoid fines and penalties, it is paramount for your medical group to return any overpayment immediately. In the event your staff does not recognize the funds as too much, you can expect to receive a letter from your Medicare Administrative Contractor. Contractors send these letters when they find an overpayment exceeding $25. 

You will receive a demand letter

This letter contains pertinent information to your case, such as reason for the overpayment, how much interest you will accrue and your appeal rights. You have a few options available to you once you have this letter. You can choose to make an immediate payment. However, you can also choose immediate recoupment, which involves the overpayment offsetting a future payment. 

Provide a rebuttal or appeal

In the event you feel as though you do not owe the Medicare Administrative Contractor any money, you can submit a rebuttal. You need to do this within 15 calendar days. Your letter should express why you feel the contractor should not initiate a refund. The MAC will need to promptly review your letter.

You can also file an appeal. There are five different levels you will need to go through to have a chance of a successful appeal:

  • MAC
  • Qualified Independent Contractor
  • Administrative Law Judge
  • Medicare Appeals Council
  • U.S. District Court

Referral to treasury

In the event you do not pay back the money within the given timeframe and do not file an appeal, then there is a chance your MAC will send your case to the Treasury Offset Program. To collect the funds, this organization may resort to phone calls, skip tracing or a federal salary offset to collect the money. 

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