Get Overpayment Recovery Form For Cgs Ohio

Filling out the Overpayment Recovery Form for Cgs Ohio online is an essential task for providers looking to refund overpayments to Medicare. This guide offers step-by-step instructions to ensure the process is smooth and efficient for everyone involved.

Follow the steps to complete the Overpayment Recovery Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin by entering the contractor's deposit control number as well as the date of deposit. Be sure to include the contractor's contact information including their name, phone number, extension, address, and fax number.
3. In the section designated for the provider, physician, supplier, or other entity, fill in your name, address, provider number, tax ID number, and contact person's details.
4. Input the amount of the check you are refunding, along with the check number and the check date.
5. For the refund information, provide details for each claim, including the patient's name, HIC number, Medicare claim number, the amount refunded, date of service, and the reason code for the claim adjustment.
6. If there are multiple claims involved, list all claim numbers and mention any additional sheets necessary for completeness.
7. For institutional facilities, specify any relevant cost report years and provide a breakdown by amount.
8. Answer the questions regarding your corporate integrity agreement with OIG and whether you are participating in the OIG self-disclosure protocol.
9. Review all provided information for completeness and accuracy. Make sure to include any additional details necessary for claim adjudication.
10. Once you have completed all sections of the form, save your changes, and you can choose to download, print, or share the form as needed.

Complete your Overpayment Recovery Form online to ensure a timely and accurate refund process.