As a medical professional, a time may come when you receive a Medicare overpayment, which is a payment you receive that exceeds the amounts allowed under current Medicare rules and regulations. Once you receive a Medicare overpayment, it becomes your responsibility to return the excess amount to the federal government, and the Centers for Medicare & Medicaid Services track those who receive overpayments to ensure they repay their debts.
Medicare overpayments occur for a variety of reasons, but the three most common causes include administrative and clerical errors, medical necessity errors and insufficient documentation. In some cases, you may catch the error before Medicare, in which case you must report and return the funds within a specific time frame. If Medicare identifies the error before you notice it, you can expect to receive a demand letter relating to the overpayment.
Options after receiving an overpayment notification
Once you receive notification about your Medicare overpayment, you have a number of options. You can promptly repay the overpayment amount, or you can request an immediate repayment recoupment, which occurs when Medicare withholds interim payments until they recoup the initial overpaid amount. You may also take part in standard recoupment, which will happen automatically without you having to file or send anything.
If you are unable to repay the full amount within the allotted time frame, you may be able to request an Extended Repayment Schedule. If you do not believe Medicare should begin the recoupment process, you can submit a rebuttal within 15 days from the date you receive the demand letter. Finally, you have the option to appeal the overpayment decision and request an independent review of your specific case.
While you have options when it comes to how to respond to a Medicare overpayment notification, you must typically adhere to certain timelines and deadlines in doing so. Virtually all health care providers will receive Medicare overpayment demand letters at some point, so understanding how and when to respond to them is critical.