US · guidance
CMS Pub. 100-08, ch. 8, § 8.2.1
Overpayment Assessment Procedures
After an overpayment determination is made concluding an incorrect amount of money
has been paid, contractors must assess an overpayment. The assessment options vary
depending upon the type of sample used when identifying beneficiary claims for
inclusion in the postpayment review. Whenever possible, CMS encourages contractors to
report postpayment savings in terms of:
• Actual overpayment;
• Settlement based overpayment, or
• Extrapolated overpayments.
A. Example Format of An Overpayment Worksheet (also see Exhibit 46)
Provider/Supplier Name
Provider/Supplier National
Provider Identification Number
(NPI) or Provider Transaction
Access Number (PTAN)
Reason for Review
Type of Sample Reviewed:
Statistical Sampling for
Overpayment Estimation
Explanation of Sampling
Methodology:
Number of Claims in Sample
Number of Claims in Universe
Amount of Overpayment (after
allowance for deductible and
coinsurance)
Claims Reviewed
Billed Amount
Allowed Amount
Rationale for Denial
§1879 Determinations
§1870 Determinations
Total Actual Overpayment
Overpayment extrapolated over
the universe
History
(Rev. 670, Issued: 08-19-16, Effective: 11-23-16, Implementation: 11-23-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
bf3d36151361d7fc37ba1927ce6e25462001ecead7832b6ad6193a3c7f7183be
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