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Overpayment Request Submission Reminders

Overpayments are Medicare payments a provider or beneficiary has received in excess of amounts due and payable under the statute and regulations. Once an overpayment has been discovered, the amount is a debt owed and should be returned to First Coast.

Complete the Return of Monies Voluntary Refund Form:

  • Include a check for the total amount of the overpayment
  • If a demand letter was received, please send one check for the amount of the letter even if multiple accounts are included
  • If you are a SPOT user, you can submit the Part B overpayment form via the Submit Documentation Feature
  • Specify the claim line details such as procedure code(s) and amount

  • Indicate if the entire claim has been overpaid or just certain claim lines

  • If the amount of deductible or coinsurance liability collected from the beneficiary changes because of the identified overpayment, the provider must return the over collected funds to the beneficiary as appropriate
  • If your submission includes multiple overpaid claims, please complete one refund form and send the details on an Excel spreadsheet

If returning an overpayment due to Medicare Secondary Payer (MSP), please provide the following items:

  • Primary insurer's explanation of benefits
  • Type of MSP involved
  • Other insurer information
  • Employer information if applicable
  • Date of loss (if available)

Regardless of how Medicare is notified of the overpayment, the following information must be provided:

  • Provider name and number
  • Medicare Beneficiary ID Number(s)
  • Claim number(s)
  • Date of service
  • Reason for overpayment
  • Amount of overpayment
  • Method of repayment
  • Copy of the primary insurance explanation of benefits (MSP situations only)
  • If you do or do not have a Corporate Integrity Agreement with the Office of Inspector General (OIG)
  • If you are or are not participating in an OIG Self-Disclosure Protocol

Remembering to include the above information will assist in accurately processing the request. For more information about overpayments, please visit our Frequently-Asked Questions Pertaining to Overpayments.