When a provider determines that a Medicare overpayment exists, the following steps must occur.

Complete the Return of Monies Voluntary Refund Form

• Provide a refund check
• List all Medicare claim numbers included in the overpayment or a copy of the Medicare remittance notices with detailed claim information (Name, Medicare ID #, date of service, procedure code and billed amount)
• Include the other insurer’s Explanation of Benefits (EOB) and/or payment information for every claim involved. The other insurer’s EOB must have the insurer’s name and address.