US · guidance
CMS Pub. 100-04, ch. 30, § 140.3
Time Limits for Making Refunds
A required refund must be made within specified time limits. Physicians who knowingly
and willfully fail to make refund within these time limits may be subject to civil money
penalties and/or exclusion from the Medicare program. Under §1842(1) , a refund of any
amounts collected must be made to the beneficiary within the following time limits:
• If the physician does not request an appeal of the initial denial or reduction in
payment within that time, the refund must be made to the beneficiary within 30
days after the date the physician receives notice of the initial determination. (See
§140.6 for notice requirements.); or
• If the physician requests an appeal within 30 days of receipt of the notice of the
initial determination, the refund must be made to the beneficiary within 15 days after
the date the physician receives the notice of the appeal determination.
History
(Rev. 1186, Issued: 02-23-07; Effective: 01-01-06; Implementation: 05-23-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ef411c94eafb22a0c7f003e5204adadaa623d896b8cf076c823d902f1c2cbb0f
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