Making Voluntary Refunds to Medicare

If you discover that an overpayment of Medicare funds has occurred, you are expected to notify the program and take appropriate actions to remedy the situation.

Please complete and forward the appropriate information to NHIC, your Medicare contractor. The attached form is required, or a similar document containing the following information, to accompany every unsolicited/voluntary refund so that receipt of check is properly recorded and applied. If specific patient/HIC/Claim # information is not provided, no appeal rights can be afforded with respect to the refund. Providers/physicians/suppliers, and other entities who are submitting a refund under the OIG’s Self-Disclosure Protocol or who are under a CIA, are not afforded appeal rights as stated in the signed agreement presented by the OIG.

National Heritage Insurance Company (NHIC) would like to emphasize the importance of submitting voluntary refunds with proper information to ensure that the refund is processed accurately and on a timely basis. All funds returned to the program should include relevant information to properly account for the refund.

• Fill out the “Overpayment Refund Form” completely for each claim, (if available, submit a copy of the Remittance Advice (RA) or Medicare Summary Notice (MSN) with the claim highlighted and notated with the exact amount of the refund and the reason for the refund), or
• Submit a spread sheet listing the following information for each claim:
  • Claim Internal Control Number (ICN) from the Medicare RA/MSN
  • Patient HIC Number from the Medicare RA/MSN
  • Patient’s Name as shown exactly on the Medicare RA/MSN
  • Date of Service
  • Procedure Code
  • Refund Reason
  • Refund Amount
  • For OIG Reporting Requirements
• Do you have a Corporate Integrity Agreement with OIG? :: Yes ::No
• Are you a participant in the OIG Self-Disclosure Protocol? :: Yes :: No

In addition

• Be sure to use the claim identifying information from the Medicare RA/MSN that you received. Do not use your own internal account numbers, patient numbers, or invoice dates, etc.
• Make checks payable to: Medicare
• Submit Medicare Secondary Payer (MSP) refunds to:
  • For New England: Medicare Cash Accounting, P.O. Box 9103, Hingham, MA 02044
  • For Northern California: Medicare Secondary Payer Refunds, P.O. Box 951, Marysville, CA 95901
  • For Southern California: Medicare Cash Accounting, P.O. Box 515301, Los Angeles, CA 90051-6601
• Submit all other refunds to
  • For New England: Medicare Cash Accounting, P.O. Box 9103, Hingham, MA 02044
  • For Northern California: Medicare Cash Accounting, P.O. Box 391, Marysville CA 95901
  • For Southern California: Medicare Cash Accounting, P.O. Box 515301, Los Angeles, CA 90051-6601