Railroad Medicare MSP Overpayment Calculator


 

 

Palmetto GBA's Railroad Medicare offers providers the ability to estimate the amount to reimburse or return to Medicare when an overpayment exists. The online calculator is designed to provide an estimate only. The results can vary depending on the data used in the computation.

Calculations are based on the following:Medicare Secondary Payer (MSP) General Provisions

Calculating Medicare secondary payments for services reimbursed on reasonable charge or other basis under Medicare Part B.

A. General — When a proper claim has been filed (i.e., a claim that is filed in a timely manner and meets all other filing requirements of the TPP), the amount of secondary benefits payable is the lowest of the:

 

 

  • Actual charge by the physician or supplier (or the amount he or she is obligated to accept as payment in full if that is less than the charges) minus the amount paid by the TPP
  • Amount Medicare would pay if services were not covered by a TPP (the payment limitations in §§2470 and 2472 for non-inpatient psychiatric services and in §2480 for physical therapy services apply in determining this amount)
  • Higher of the Medicare fee schedule or other amount that would be payable under Medicare (without regard to any Medicare deductible and/or coinsurance amounts) or the TPP's allowable charge (without regard to any co-payment imposed by the policy or plan) minus the amount actually paid by the TPP

MSP Calculator





Last Updated: 01/04/2021