US · guidance
CMS Pub. 100-08, ch. 8, § 8.2.1.1
Definition of Overpayment Assessment Terms
A. Actual Overpayment
An actual overpayment is, for those claims reviewed, the sum of payments (based on the
amount paid to the provider/supplier and Medicare approved amounts) made to a
provider/supplier for services which were determined to be medically unnecessary or
incorrectly billed.
B. Projected Overpayment
A projected overpayment is the numeric overpayment obtained by projecting an
overpayment from statistical sampling for overpayment estimation to all similar claims in
the universe under review.
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
3fe8818bb3418ffa7543ef2c5949fecf4bbea1bc7a9ea60935c43573f36d0293
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