Wiki Medicare Advantage Refund Request


Fort Wayne, IN
Best answers
Doe any one know if CMS has a time period for refund requests? Can they go back unlimited number of years and request a refund?

The NGS Medicare 101 manual doesn't state anything. I have also reviewed the CMS IOM Chapter 3 - Overpayments and Chapter 4 - Debt Collection and I was unable to find any thing that states a time frame for refund requests. NGS customer service was unable to provide an answer either.

Thanks in advance for any replys!
If you look in the Federal Register you should be able to do a search to find the information. However, the CMS guidelines state that you must refund the money no more than 30 days after the account becomes a credit balance. Also, they can request refunds far back but, more than likely they will recoup the money from a future remittance if you do not refund.
CMS refund recoup

From the last Medicare seminar I went to, I believe they stated that CMS can only recoup refunds from physicians as far back as four years. If medicare is requesting the refund you have upto 30-days to refund the money.

Jennifer D.