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.


CLAIMS OVERPAYMENT RECOVERY PROCEDURE

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.

what is demanded debt - immediate offset

Q. Can I request early or immediate offset of a demanded debt?

A. Yes. When you receive an overpayment demand letter indicating a refund is due, you can request immediate offset of the debt in writing.

The immediate recoupment process allows providers to request that recoupment begin prior to day 41. Providers who elect this option may avoid paying interest if the overpayment is recouped in full prior to day 31. The immediate recoupment process does not terminate appeal rights.
An immediate offset is considered a voluntary repayment. Keep in mind a request for an immediate offset will occur only as funds become available. Providers who choose immediate recoupment must do so in writing. However, a provider can terminate the immediate recoupment process at any time.
The advantages of utilizing this new process include:

§ Avoiding the possibility of checks “crossing in the mail”
§ Cost savings associated with check fees and postage
§ Avoiding potential interest accrual due to late receipt of refund
To request immediate offset of demanded debt, complete the Medicare Debt Recovery: Request for Immediate Offset form  and fax the form to:
Part A Debt Recovery (904) 361-0320 or Part B Debt Recovery (904) 361-0444.
Note: The fax numbers indicated are for immediate offsets of a demanded debt only. Any other financial concerns should be sent in writing to the appropriate Part A or Part B Medicare department.
To ensure your request is handled promptly, all requests must include:
• Date of Request
• Which option the provider is requesting?
• One-time request for immediate recoupment of a current overpayment letter (All ARs in the overpayment letter will be placed on immediate offset)
• Request for immediate recoupment of a current overpayment letter and all future overpayments (Future immediate offset requests must include a request for immediate offset of a current overpayment letter.)

• Letter Number
• Provider Name
• Provider Medicare number and/ or national provider identifier
• Signature of provider or Chief Financial Officer
• Telephone number

• The request must specifically state that the provider understands that they are waiving potential receipt of interest payment pursuant to Section 1893(f)(2) for the overpayments.
Incomplete requests may delay processing, which can cause interest to accrue on the debt. If there is a remaining principal balance after the initial immediate recoupment request has been processed, attempts to recoup immediately will continue. Interest will accrue from the date of the demand letter if a principal balance remains after 30 days from the date of the demand letter and further collection activities will be pursued. As with all transactions of this nature, the sooner you make the decision to request an immediate offset, the more likely the offset will activate prior to interest accrual.
Please indicate Immediate Offset on the fax cover sheet.

Preventing duplicate claim denials

Claim system edits search for duplicate and repeat services within paid, finalized, pending and same claim details in history. Therefore, unless applicable modifiers are included on your claim, the edits may detect same, or similar, duplicate services. Please share this information with your billing companies, vendors and clearing houses.

To prevent duplicate claim denials and ensure you are billing correctly, review your billing software and procedures. Some services on a claim may appear to be duplicates when, in fact, they are not.

Use modifiers, as applicable, to identify procedures and services that are not duplicates. A complete list of modifiers can be found in the Current Procedural Terminology (CPT®) codebook. The following are a few examples of modifiers that may be used to indicate repeat, or distinct, procedures and services:

• Modifier 76 may be used to indicate a repeat procedure or service by the same provider, subsequent to the original procedure or service.
• Modifier 91 may be used to indicate repeat clinical diagnostic laboratory tests. This modifier is added only when additional test results are medically necessary on the same day.
• Modifier 59 may be used to identify procedures or services that are normally reported together but are appropriate to be billed separately under certain circumstances. Modifier 59 indicates a procedure or service by the same provider, distinct or independent from other services, performed on the same day.