Medicare Part B Recoupment
Cahaba performs recoupment services for Medicare Part B in Alabama, Georgia and Tennessee. There are two primary ways of recouping money: voluntary refunds and solicited refunds. Voluntary refunds come from providers who return overpayments without any notices from Medicare. Solicited refunds are refunds requested from providers by Medicare.
The acceptance of a voluntary refund in no way affects or 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 these or any other claims.
Q1. How do I as a provider handle a Part B voluntary refund?
A1. As stated in Change Request 3274, an “Overpayment Refund Form” should accompany every unsolicited/voluntary refund so that receipt of the submitted check is properly recorded and applied.
Please note the following:
– For all Non-MSP refunds, bulk checks are accepted and preferred when there are multiple claims involved. When sending a bulk check, please include a copy of the remit, and indicate which claims tie back to this refund check. This request does not apply to MSP. For all MSP refunds, one check should be submitted for each beneficiary. Please do not submit bulk refund checks for multiple beneficiaries when Medicare Secondary Payer is involved. Non-MSP and MSP Voluntary refunds should be sent on separate checks when refunding.
The Overpayment Refund Form will provide Medicare with the information needed to for proper processing. Processing of the refund will be delayed if the requested information, noted in the form, is not included. If any of the requested information is omitted, Medicare will need to contact the provider directly to find out this information before the refund can be processed. Also, please include a copy of the remittance highlighting the inappropriate payment
Please note the following:
If specific patient/HIC/Claim # information is not provided, no appeal rights can be afforded with respect to the refund. Providers/physicians/suppliers, and other entities that are submitting a refund under an OIG Self-Disclosure Protocol are not afforded appeal rights as stated in the signed agreement presented by the OIG.
Also, per Change Request 3274, “Contractors shall only refund excess recoupments when no other outstanding accounts receivable exists, or written documentation/evidence clearly supports that Medicare is not entitle to the money or was not the intended recipient of the refund check.”
Q2. How do I as a provider handle a Part B solicited refund?
A2. Refunds are solicited when Cahaba’s Financial examines a referral from another unit (i.e., Provider Call Center, Appeals, Medical Review) and determines that an overpayment has been made to a provider. At that time, Financial sends a letter to the overpaid provider requesting a refund. Providers must enclose a copy of the invoice letter with the refund check. Please note that in lieu of sending in a check for the amount of the overpayment, you may make a request for Financial to offset the amount you owe on your next remit.
Q3. Where do I send Part B refund checks?
A3. Cahaba utilizes a lockbox to deposit overpayment checks received from providers and the checks will be deposited within 24 hours of receipt. All checks should be made payable to Cahaba GBA and include a copy of the voluntary refund form or demand letter, as applicable, along with any additional documentation that would enable processing of the request.
For overpayments resulting from demand letters, please send separate checks from those being voluntarily refunded. In addition, please send separate checks for refunds for Medicare Secondary Payer (MSP) and Non-MSP payments. For all MSP refunds, be sure to include the primary insurer’s Explanation of Benefits.
The lockbox address is:
Cahaba Medicare Part B
P O Box 7247
Philadelphia, PA 19170-6029
Q4. What happens if someone ignores a recoupment solicited refund request from Cahaba for Medicare Part B?
A4. If there is no response after 30 days, on the 31st day, interest begins to accrue. If there is no response to the demand letter by the 41st day, the offset process begins. Unless the debt is in an appeal status, the debt will be recouped from other claim payments. The intent to refer process starts on the 119th day, and amounts not collected by the 180th day are referred to the United States Department of Treasury for collection.