US · guidance
CMS Pub. 100-06, ch. 6, § 340
Exhibit - Medicare Program Carrier Beneficiary Overpayment Activity
Report - (Form CMS-2174)
(Rev. 6, 08-30-02)
B3-13379
MEDICARE PROGRAM CARRIER BENEFICIARY OVERPAYMENT ACTIVITY
REPORT
CARRIER NUMBER ________________ REPORTING PERIOD ______________
NUMBER
OF
CLAIMS
AMOUNT
OF
MONEY
A.BENEFICIARY OVERPAYMENTS
1. PENDING START OF QUARTER
2. ADJUSTMENTS TO OPENING PENDING
3. ADJUSTED OPENING PENDING
4. DISCOVERED DURING REPORTING QUARTER
5. DISPOSITIONS
6. COLLECTED
7. RECOUPED BY OFFSET
8. RECOUPED BY REFUND
9. UNCOLLECTIBLES
10. REFERRED TO REGIONAL OFFICE
11. WAIVED BY CONTRACTOR
12. ABANDONED IN ACCORD WITH MAN. INSTR.
13. PENDING END OF QUARTER
B. CAUSE OF OVERPAYMENTS
14. BENEFICIARY NOT ENTITLED
15. SERVICES NOT COVERED
16. CHARGE EXCEEDED REASONABLE CHARGE
17. PAYMENT MADE TO WRONG PAYEE
18. DUPLICATE PAYMENT
19. MEDICALLY UNNECESSARY SERVICES
20. SERVICES NOT RENDERED
NUMBER
OF
CLAIMS
AMOUNT
OF
MONEY
21. MEDICARE SECONDARY PAYER
22. DOCUMENTATION/CODING/DATA ENTRY
23. OTHER
C. HOW OVERPAYMENTS WERE DISCOVERED
24. REPORTED BY BENEFICIARY OR SUPPLIER
25. CMS's CARRIER QUALITY CONTROL
PROGRAM
26. CARRIER INTERNAL AUDIT OR REVIEW
27. GOVERNMENT AGENCY
28. OTHER METHODS OF DISCOVERY
Monthly Statistical Report on Carrier Appeal Activity
History
(Rev. 6, 08-30-02)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
4e6b6aeb0b14e8f8d14cc5c0c1bd4a99351acc2ca04d1aa905e6dc3bfa9c761e
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