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  • Voluntary Refund Request Form Jurisdiction C

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DME MAC Jurisdiction C Voluntary Overpayment Refund Provider/Physician/Supplier or Other Entity Information Date Please complete and forward to your Medicare contractor at the address or fax number located at the bottom of the form. This form or a similar document containing the following information should accompany every unsolicited/voluntary refund so that receipt of check is properly recorded and applied. Address City State PTAN/NPI Number Zi.

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Related content

R315FM 05 - CMS Manual System
May 17, 2019 — 5/410/410.4/Receiving and Processing Unsolicited/Voluntary Refund Checks...
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26 CFR § 1.6050E-1 - Reporting of State and local...
Section 6050E and this section apply to any refund officer who, with respect ... a State...
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2017 General Instructions for Forms W-2 and W-3...
May 2, 2017 — your region, and more. Preview ... Furnishing. Copies B, C, and 2 of Forms...
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To get a refund or reimbursement from Medicare, you will need to complete a claim form and mail it to Medicare along with an itemized bill for the care you received. Medicare's claim form is available in English and in Spanish.

The Overpayment Rule requires the reporting and returning of “overpayments” to CMS within 60 days of identification. The Overpayment Rule applies to Medicare Parts A – D.

Under the current 60-day Rule, an overpayment must be reported and returned within 60 days of identification to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, and must also notify that entity in writing of the reason for the overpayment.

If an overpayment is not returned to Medicare within 30 days, it becomes a violation of the False Claims Act. Billing for services never rendered is one of the most common types of healthcare fraud.

CMS is proposing to revise the standard for “identification” of an overpayment under what is commonly referred to as the 60-Day Rule. Federal statute establishes an overpayment must be returned within 60 days “after the date on which the overpayment was identified.” 42 USC 1320a-7k(d)(2).

Federal law requires the Centers for Medicare & Medicaid Services (CMS) to recover all identified overpayments. When an overpayment is $25 or more, your Medicare Administrative Contractor (MAC) initiates overpayment recovery by sending a demand letter requesting repayment.

Section 1128J(d) of the Act provides that an overpayment must be reported and returned by the later of: (i) the date which is 60 days after the date on which the overpayment was identified; or (ii) the date any corresponding cost report is due, if applicable.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232