When Your Medicare Cup Runneth Over – Review of Ophthalmology

The Centers for Medicare & Medicaid Services defines an overpayment as money received, usually from a third party payer, based on a claim for reimbursement that should not have been paid. An overpayment may be all or part of the payment received. It may be the result of an unintended mistake or caused by intentional misrepresentation. It may be an isolated occurrence or a recurring problem. Overpayments are clearly wrong. They are not disputed amounts due to differences of opinion.

This article addresses the following questions:

  • Is there a definition of an “overpayment”?
  • Are there common causes resulting in overpayments?
  • Is the provider or facility expected to refund an overpayment?
  • What is the time frame for returning an overpayment once discovered?
  • Is an attorney required to make a refund of an overpayment?
  • What is the process for voluntarily refunding overpayments to Medicare and other payers?
  • What information should be sent along with the refund check?
  • If I make a voluntary refund, will this prompt the payer to conduct an audit?
  • Is refunding an overpayment sufficient to address the problem?
  • Is there a way to prevent overpayments?
  • Can an overpayment be treated as fraud?

This article was published in Review of Ophthalmology’s Medicare Q & A column, which is written by Corcoran’s Vice-President, Donna McCune, CCS-P, COE, CPMA. To view the entire article in Review of Ophthalmology, click on the link below:


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