Overpayments

Published 09/22/2022

If Railroad Medicare receives a refund for an overpayment that has already been recouped, we will determine whether the provider has any other outstanding overpayments. If one or more overpayments are found, the refund will be applied partially or fully to that debt. Any funds remaining after all debts are closed will be returned to the provider. 

Last Reviewed: 9/22/2022

As of October 1, 2010, Palmetto GBA no longer allows providers to request an immediate offset as a payment method relating to voluntary/self-disclosed Medicare overpayments. Providers should submit a check made payable to Palmetto GBA or Medicare with the overpayment refund form. If the check payee is addressed differently, it will be returned to the provider. Overpayment refund forms received without check payment will be processed under established collection procedures mandated by the Centers for Medicare & Medicaid Services (CMS).

As an alternative to this, a provider may request an immediate offset once an overpayment has been established and a demand letter has been sent. Once you receive the Palmetto GBA Medicare refund notification, an immediate offset request can be submitted to our office.

Note: An immediate offset request will be processed as soon as possible; however, this request does not guarantee that interest will not accrue on the overpayment. To reduce the risk of interest accruing on a voluntary refund, attach a check to the overpayment refund form.

To request an immediate offset for an established account receivable:

  • Fax a copy of the "Overpayment Detail Listing" page of the overpayment demand letter showing the account receivable number to be placed in immediate offset status
  • Indicate "Immediate Offset" either on the demand letter or on the fax cover sheet 
  • Fax this information to Railroad Overpayments at (803) 382–2418 

Last Reviewed: 9/22/2022

No. Voluntary refunds via immediate offset are not allowed by the Centers for Medicare & Medicaid Services (CMS) and are not available through the eOffset feature in eServices. You may only submit an eOffset request once you have received a demand letter or invoice for the overpayment. 

If you wish to submit a voluntary refund, you may use our eCheck feature to conveniently resolve your overpayment via a secure electronic payment transaction. When submitting your payment, simply indicate on the eCheck form that your payment is not associated with a demand letter and upload a copy of your voluntary refund form and documentation. The eCheck feature is easily accessible from the Financial Tools tab.

Last Reviewed: 9/22/2022

Palmetto GBA offers immediate offset requests and electronic payments for Medicare overpayments and voluntary refunds in eServices.

If you are a provider administrator, you may access the Financial Forms subtab under Financial Tools. If you are a provider user, you must be granted permission to eCheck and eOffset by your provider administrator.

Access the Financial Forms subtab to submit immediate offset requests for Medicare overpayments or eCheck electronic payments for Medicare overpayments and voluntary refunds online. Just select the desired form from the drop-down menu and the form link will display at the bottom of your screen. Click on the form link and complete the form. You may attach PDFs up to 40 MB each in size. The total size of all attachments cannot exceed 150 MB.

Note: You have the option to request an immediate offset when you receive a demanded overpayment or make a permanent request for all future demanded overpayments. Voluntary refunds may be handled through eCheck submissions.

Once the form is submitted, you will receive a message in your message inbox either advising you how to correct the form for resubmission or that the form was submitted successfully. You will get a second message with the DCN when the form has begun to be processed. You can use the DCN to look up form processing status and view your submitted forms. If a form is submitted over the weekend, the DCN may not be assigned until the next business day.

Last Reviewed: 9/22/2022

Please follow these three steps to submit your immediate offset request:

  • Fax a copy of the overpayment detail listing page of the overpayment demand letter to (803) 382–2418. This page includes the account receivable number that you would like to have placed in immediate offset status.
  • Indicate Immediate Offset either on the overpayment detail listing page or on the fax cover sheet
  • Fax this request only once and keep your fax confirmation sheet that your fax machine generates as proof of your notification to Railroad Medicare. Faxing multiple copies of the same request causes a delay in processing the immediate offset.

If you have any questions about the immediate offset process, please call the Railroad Medicare provider contact center at 888–355–9165. Telephone representatives are available from 8:30 a.m. to 4:30 p.m. in all time zones with the exception of Pacific Time, which receives service from 8:30 a.m. to 4 p.m. PT.

Last Reviewed: 9/22/2022

We try to process immediate offset requests as soon as possible, but at least within 10 days of receipt. In order for your debt to offset, you must have claims currently being processed and paid. Your debt will remain in offset status and collect against as many claims as needed until the balance is $0.00.

You can elect the immediate offset process to avoid making a payment by check and/or avoid the assessment of interest if the immediate offset satisfies the overpayment in full before aging 31 days from the initial demand.

Please Note: An immediate offset request will be processed as soon as possible; however, this request does not guarantee that interest will not accrue on the overpayment. To eliminate the risk of interest accruing, your request should be submitted as soon as possible after being notified of the debt as interest automatically accrues 31 days from the date of the initial demand letter.

Last Reviewed: 9/22/2022

The only way an outstanding overpayment can offset is if a provider is actively submitting claims and those claims process to pay. These payments will be withheld toward the outstanding overpayment that is in offset status. If there are no claims processing, there will not be any claim payments to offset the overpayment.

Note: Immediate offset requests may only be accepted on solicited overpayments where the provider has received a demand letter from Medicare. Effective October 1, 2010, Palmetto GBA will no longer allow providers to request immediate offset related to voluntary/self-disclosed overpayments. In these situations, a provider should submit a check.

Last Reviewed: 9/22/2022

Medicare is the Primary Payer

Scenario Use This Paper Form Use This eServices Secure Form
You are submitting a refund payment with the form Voluntary Refund Overpayment: Check Enclosed Financial Tools: eCheck
You are NOT submitting payment with the form because you require a demand letter to be issued after the claim is adjusted Reopening: Simple Claim Correction Forms: Reopening: Simple Claim Correction

Medicare is the Secondary Payer

 Scenario Use This Paper Form Use This eServices Secure Form
You are submitting a refund payment with the form Medicare Secondary Payer Refund Overpayment — Check Enclosed
AND include a copy of the primary insurance EOB
Financial Tools: eCheck AND attach a PDF copy of the primary insurance EOB
You are NOT submitting payment with the form because you require a demand letter to be issued after the claim is adjusted Reopening: Simple Claim Correction
AND include a copy of the primary insurance EOB
Forms: Reopening: Simple Claim Correction
AND attach a PDF copy of the primary insurance EOB

NOTE: For MSP scenarios, if you do not have a copy of the primary insurance EOB, please complete and include a Medicare Secondary Payer Explanation Form.

Last Reviewed: 9/22/2022

If you have a question about the reason for the overpayment, please contact the Quality Payment Program (QPP) Help Desk either by telephone at (866) 288–8292 or by email at qpp@cms.hhs.gov.

Last Reviewed: 9/22/2022