Reminder: Medicare Part B Voluntary Refunds

Providers submitting voluntary refunds need to be aware that when completing the Part B Voluntary Overpayment Refund Form, additional claim data is required:

1. Complete the Part B Voluntary Overpayment Refund Form in its entirety.
   1. Missing information will delay processing.
   2. Include LVAM form for large-scale refund.
   3. The check amount shall match the LVAM data.
2. Be sure the form is mailed to the appropriate address listed at the bottom of the form.
3. Include any additional documentation that would enable processing of the request.

Forms

• Jurisdiction K Part B Overpayment Recovery Unit Voluntary Refund Form
• Jurisdiction 6 Part B Overpayment Recovery Unit Refund Form
• Large Various Adjustment Macro (LVAM) Form

Complete details and required forms are located on our Overpayment web page.

Posted: 5/17/2021