Overpayments

Overpayment Request

Table of Contents

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Forms You'll Need

Forms for non MSP-related are generally done via NGSConnex, but in the event you cannot do a full claim adjustment in NGSConnex to create the account receivable, you may complete clerical error reopenings via the Part B Reopening Request Form

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Large Scale Overpayments

When submitting a request for correction of 25 or more for the same or similar situation, please complete a Part B Reopening Request Form and attach the Large Various Adjustment Macro (LVAM) form. This form will help to ensure that the correct claims are identified for the adjustments being requested. This also prevents us from having to contact your office for further clarifications.

Forms used for providers NOT on Automatic Immediate Recoupments and checks are attached to this form(s)

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Overpayment Notification Process

Easy steps to claim corrections whether the claim reopening is an underpayment or an overpayment.

Providers who are registered to use NGSConnex, should use this option to submit reopening requests electronically.

Providers may use the Part B Reopening Request Form when the claim has been purged from NGSConnex.

When requesting multiple correction(s) for the same or similar situation, providers must attach the Large Various Adjustment Macro (LVAM) form to the Part B Reopening Request Form.

Scenario Form(s) Instructions
Provider-Initiated claim correction due to overpayment

Provider ON automatic immediate recoupments		 Complete a reopening:
NGSConnex or Part B Reopening Request Form		 Do not send any checks to NGS for overpayments.

If your organization is on automatic immediate recoupments, nothing further is required.

Netting will occur within 16 days from the demand letter.

Note: Ensure you are regularly submitting Medicare claim payments.
Provider-Initiated claim correction due to overpayment

Providers NOT on automatic immediate recoupments		 Step 1: Complete a reopening:
NGSConnex or Part B Reopening Request Form

Step 2: When you receive a demand letter, send a check and a copy of the first page of the demand letter to the appropriate lockbox at right.

If your organization is NOT on automatic immediate recoupments and would like the automated process, you may register via Immediate Recoupment Request Form - Electronic/Email.		 Jurisdiction 6:
(IL, MN, WI)
National Government Services, Inc.
P.O. Box 809194
Chicago, IL 60680-9194

Jurisdiction K:
(CT, NY, MA, ME, NH, RI, VT)
National Government Services, Inc.
P.O. Box 809645
Chicago, IL 60680-9645
  1. Complete form entirely. Missing information will delay the processing.
  2. Be sure the form is mailed to the appropriate address based on contractor jurisdiction.
  3. Include a contact person, telephone numbers, and any additional documentation that would assist with processing of the request.
If you received a demand letter, please follow one of the following steps.
  1. If you are set up for immediate recoupments for all and future, no further form/action is required. (Please note you must be actively billing for recoupment to occur.)
  2. If you are NOT set up for immediate recoupments:
    1. timely reimbursement is required to avoid interest accrual
    2. you may complete the immediate recoupment form (paper or electronic) and be sure to check the appropriate box:
      1. A one-time request for all current overpayment(s) addressed in the referenced demand letter and all future overpayments.
      2. Request for all current overpayment(s) addressed in the referenced demand letter only.
  3. Submit a Rebuttal.
  4. Submit an Extended Repayment Schedule (ERS).
  5. Submit your first level of an appeal (Redetermination).
  1. Automatic immediate recoupment form (paper or electronic) Mailing a check is a great way to avoid interest accrual.
  2. Mail a check or request an automatic immediate recoupment.
  3. Submit a Rebuttal.
    • Rebuttal is not an appeal.
    • Rebuttal shall be submitted to NGS within 15 calendar days from the date of a demand letter.
    • In your rebuttal statement, you will need to explain or provide evidence as to why NGS should not initiate recoupment.
  4. Submit an Extended Repayment Schedule (ERS) if you are unable to pay the overpayment in full within the required timeframe noted in the demand letter, NGS offers an ERS process. This will allow providers or beneficiaries to make installments if an overpayment that cannot be made within 30 days. ERS are generally requested on large scale overpayments and shall be requested within 30 days of the demand letter date.
  5. Submit your first level of an appeal (Redetermination) if you disagree with the overpayment request.

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Timeline for Processing a Demand Letter

  1. Medicare identifies an overpayment.
  2. Demand letter is mailed.
  3. Provider is given 30 days from the date of the letter to pay the requested amount before the receivable starts accruing interest.
  4. If the provider decides to request immediate recoupment, they may complete the immediate recoupment form or submit electronically with NGSConnex.
  5. If a check is received, it will be applied toward intended receivables in the following manner:
    1. In the event there is interest, the check is first applied toward the interest owed and then applied toward the principal.
    2. If the intended overpayment has previously been offset or satisfied, CMS policy requires the check be applied toward any of the provider’s or affiliated providers' outstanding receivables first before refunding the monies to the provider.

Reviewed 10/17/2024