CMS Pub. 100-05, ch. 3, § 10.4

Payments Are Received

(Rev. 11874, Issued: 02-23-23, Effective: 03-24-23; Implementation: 03-24-23)

In any case in which a provider, physician, or other supplier has received a primary

payment from Medicare and a duplicate primary payment from a primary plan, the A/B

MACs and DME MACs instruct the provider, physician, or other supplier to refund to the

beneficiary any Medicare deductible and coinsurance amounts paid by the beneficiary

that were duplicated by the primary payment. If the primary payment exceeds the

deductible and coinsurance amounts, the excess constitutes a debt to Medicare because it

duplicates all or part of the amount Medicare has paid and, therefore, must be collected

from the provider, physician, or other supplier. Medicare must be reimbursed within 60

days of the receipt of the duplicate payment. A copy of the letter to the provider,

physician, or other supplier is sent to the beneficiary. Interest is applicable if repayment

is not made to Medicare within 60 days.

The MSP regulations at 42 CFR § 489.20 require providers to pay Medicare within 60

days from the date a payment is received from another payer (primary to Medicare) for

the same service for which Medicare paid. A provider refunds the Medicare payment

within 60 days by submitting an adjustment bill or via the Medicare Credit Balance

Report. The MSP regulations at 42 § CFR 411.24(h) and § 411.25 require all entities that

receive a primary payment from both Medicare and a primary plan to repay Medicare. A

physician or other supplier submits a refund check to Medicare. This refund is due

Medicare, regardless of which payment the provider, physician, or other supplier

received first and even if the insurance payment was refunded to the beneficiary or the

insurer.

Providers report credit balances resulting from MSP payments on the Form CMS-838 if

the overpayment has not been repaid by the last day of the reporting quarter. If the

provider identifies and repays an MSP credit balance within a reporting quarter, in accordance

with the 60-day requirement, it is not reported on the Form CMS-838, i.e., once payment is

made, a credit balance would no longer be reflected in the provider records.

If an MSP credit balance occurs late in a reporting quarter, and the Form CMS-838 is due prior to

expiration of the 60-day requirement, the overpayment must be included in the credit balance

report. However, payment of the credit balance does not have to be made at the time the Form

CMS-838 is submitted, but within the 60 days allowed.