CMS Pub. 100-06, ch. 6, § 330.4

B3-13360.4

This shows data on beneficiary-recoverable overpayments according to how they were discovered.

Where more than one method of discovery exists, the carrier reports the claim and dollar amount

of overpayment on only one of lines 24 - 28 according to the principal method of discovery. The

principal method is that which involves the greatest dollar amount.

Line 24. Reported by Beneficiary or Provider - The carrier enters under the appropriate

columns the number of overpayments and that part of the dollar amount reported on line 4 which

were discovered when a beneficiary or provider reported a beneficiary-recoverable overpayment.

(This includes the situation where the beneficiary was paid instead of the provider.)

Line 25. CMS's Carrier Quality Control Program - The carrier enters under the appropriate

columns the number of overpayments and that part of the dollar amount reported on line 4 which

were discovered through CMS's Carrier Quality Control Program - including both the carrier

sample and the RO sub-sample.

Line 26. Carrier Internal Audit or Review - The carrier enters under the appropriate columns

the number of overpayments and that part of the dollar amount reported on line 4 which were

discovered through its internal auditing procedures or review of subsequent claims. It excludes

cases where the overpayment was discovered through CMS's Carrier Quality Control Program.

(See line 25.)

Line 27. Government Agency - The carrier enters under the appropriate columns the number of

overpayments and that part of the dollar amount reported on line 4 which were discovered by

DHHS, GAO, OIG, or other government agency audit.

Line 28. Other Methods of Discovery - The carrier enters under the appropriate columns the

number and dollar amounts involved for overpayments discovered by methods.

The number and amount of beneficiary overpayments reported on lines 24 through 28, when

combined, should equal the number and amount reported in Section A on line 4.