CMS Pub. 100-06, ch. 3, § 110.4

Any correspondence with a beneficiary concerning an overpayment must contain a clear and complete

explanation of the overpayment. An overpayment which is not clearly explained is less likely to be

refunded. Furthermore, lack of clarity may deprive the individual of sufficient information to decide

whether there is a basis for questioning the contractor’s determination. Clarity is also important because

the letter may eventually be used by CMS for further recovery attempts.

The following is the minimum information which shall be included in all overpayment refund letters

sent to a beneficiary:

A. Name and address of physician, date and type of service, charges, date of check, amount of check,

and name of payee.

B. A clear explanation of why the payment was not correct.

C. The amount of the overpayment and how it was calculated.

D. The beneficiary is required to refund the overpayment.

E. The refund should be by check or money order, and how it should be made out (enclose a pre-addressed envelope).

F. The refund can be made by installments. (See §110.8. of this chapter)

G. Unless a refund is made, the overpayment may be withheld from other Medicare benefits payable to

the beneficiary and may be referred to the Social Security Administration for further recovery action.

H. Possible recovery from other insurance (if applicable).

I. An explanation of the beneficiary's right to a review or hearing as appropriate.

J. An explanation of the CMS/SSA waiver of recovery provisions. (See §170.3 of this chapter)