Wednesday, November 25, 2015

Overpayment FAQs

Q. What do I do if I have been overpaid because of a duplicate primary payment?

A. Medicare Secondary Payer (MSP) overpayments are processed differently than non-MSP overpayments and require a refund to be sent within sixty days of receiving a duplicate payment. Complete the appropriate Medicare Secondary Payer overpayment refund form (see below) and attach a check for the overpaid amount. In addition, the other insurer’s explanation of benefits is required for every claim involved.

Q. What do I do if I have been overpaid on a claim?

A. Once an overpayment has been determined, providers are required to repay the debt. Complete the appropriate overpayment refund form (see below) and attach a check for the amount. Specific data such as patient name, health insurance claim number and Medicare claim number must be included for claim correction and remittance revision, where appeal rights are afforded. If this data is not returned and Medicare is unable to correct records, claim(s) included in the refund may be identified as an overpayment and demanded in the future.

Q. What if the entire overpayment amount cannot be refunded at one time?

A. An Extended Repayment Schedule (ERS) can be requested if the debt cannot be paid in full. Follow instructions outlined in the Sole proprietor or Corporation/group ERS forms below and return the required documentation. Once a completed ERS has been received, a 30 percent withholding of claim payments will begin, and the withholding will continue until the review has been completed. The original documents must be mailed with the payment. Once approved, all ERS payments will be recouped from the provider’s future Medicare payments according to the approved amortization schedule, unless it has been determined that there is a valid reason for the provider to send a check.

Q. What happens when a redetermination or reconsideration appeal is requested?

A. After notice of a valid appeal request, if limitation of recoupment (Section 935 of the Medicare Modernization Act) provisions apply, all collection activities are ceased, including the withholding of future claim payments. Interest, however, will continue to accrue during the appeal process.

Q. What do I do if I receive an overpayment letter?

A. An overpayment letter is a formal request to repay a debt owed to the Medicare Trust Fund. Payment is due upon receipt of the notice. Send the payment with a copy of the overpayment letter received or request an immediate offset. Interest will accrue 30 days from the date on the overpayment letter and every thirty days thereafter. On day 40, we will immediately begin offsetting and claim payments will be withheld and applied until the entire debt is collected.
The letter number or AR number must be included with the payment in order to apply the refund properly, without delay.

Q. Can someone other than a Medicare beneficiary request a Medicare appeal on an unassigned claim?

A. Under certain circumstances, yes. The beneficiary may complete an appointment of representative form . This form is used to authorize an individual to act as a beneficiary’s representative in connection with a Medicare appeal.

Although some parties may pursue a claim or an appeal on their own, others will rely upon the assistance and expertise of others. A representative may be appointed at any point in the appeals process. A representative may help the party during the processing of a claim or claims, and/or any subsequent appeal.

The following is a list of the types of individuals who could be appointed to act as representative for a party to an appeal. This list is not exhaustive and is meant for illustrative purposes only:
• Congressional staff members,
• Family members of a beneficiary,
• Friends or neighbors of a beneficiary,
• Member of a beneficiary advocacy group,
• Member of a provider or supplier advocacy group,
• Attorneys, and
• Physicians or suppliers.

Q. Can a request for offset/recoupment be made at the same time I notify Medicare of an overpayment?

A.    No. A request must be submitted in writing.


When a claims overpayment is discovered, BCBSTX will notify the Provider. If a Provider is notified by BCBSTX of an overpayment, or discovers that they have received an overpayment, the Provider should return the overpayment to BCBSTX by mailing a check and a copy of the overpayment notification to:

Blue Cross and Blue Shield of Texas

Attn: Overpayment Recovery
P.O. Box 92420
Cleveland, OH 44193

Note: The address above cannot accept overnight packages. If you are sending an overnight package, please contact Customer Care Center at 888-292-4487.

If you believe that the overpayment was created in error, you should contact BCBSTX in writing. For a claims re-evaluation, send your correspondence to the address indicated on the overpayment notification.

If BCBSTX does not hear from you or receive payment within 30 days, the overpayment amount is deducted from your future claims payments. In cases when BCBSTX determines that recovery is not feasible, the overpayment is referred to a collection service.

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