CMS Pub. 100-04, ch. 30, § 50.15.3

Suppliers in Making Refunds

(Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21)

A required refund must be made within specified time limits:

• The refund must be made to the beneficiary within 30 days after the date the

healthcare provider or supplier receives the remittance advice (RA) if the healthcare

provider or/supplier does not request review of an initial full or partial denial; or

• The refund must be made to the beneficiary within 15 days after the date the

healthcare provider or supplier receives the notice of the review determination if the

healthcare provider or supplier requests review within 30 days of receipt of the notice

of the initial determination.

Healthcare provider or suppliers who knowingly and willfully fail to make a refund

where required within these time limits may be subject to civil money penalties and/or

exclusion from the Medicare program.

The beneficiary should contact the contractor or CMS when a healthcare provider or

supplier fails to make a timely refund. If the contractor determines that a healthcare

provider or supplier failed to make a refund, it will contact the healthcare provider or

supplier in person or by telephone to discuss the facts of the case. The contractor will

attempt to determine why the required refund has not been made and will explain the

legal requirements. The contractor will determine whether referral to the Office of

Inspector General (OIG) or CMS is appropriate and will make appropriate referrals OIG

if necessary. The OIG or CMS may impose civil money penalties, assessments, and

sanctions if he or she fails to make the required refund. The contractor will retain a

detailed written report of contact.