Submit a Voluntary Refund
A voluntary refund should be returned to Medicare any time an overpayment has been identified by a provider. Overpayments are Medicare funds that a provider, physician/supplier or beneficiary has received in excess of amounts due and payable by Medicare. Once a determination of overpayment has been made, the amount is a debt owed to the United States Government.
When you identify an overpayment the appropriate voluntary refund form and payment should be submitted.
Please note: If you would like to disclose the overpayment, but receive a demand letter before submitting payment; do not use the voluntary refund form.
- For non-MSP overpayments without a payment, please submit the “Reopening: Simple Claim Correction” form
- For MSP overpayments without a payment, please submit the “Medicare Secondary Payer Inquiry” form
How to Submit a Voluntary Refund
Providers are strongly encouraged to submit voluntary refunds electronically using the eCheck feature within the Financial Tools section of Palmetto GBA’s eServices. The eCheck function allows payments to be sent electronically to Palmetto GBA. Voluntary refunds can be submitted by using the eCheck option and selecting the option within the eCheck form indicating the payment is not associated with a demand letter. A copy of the voluntary refund form and any other relevant documents must be uploaded and attached to the eCheck to assist in processing. Once submitted, you will receive a confirmation from Palmetto GBA indicating that the payment has been received. For more information, please review the Financial Tools Section in the eServices user manual (PDF, 8.25 MB).
Providers may also mail a check payable to Palmetto GBA or Medicare, the completed applicable voluntary refund form, and any relevant documentation to the address listed at the bottom of the applicable Voluntary Refund form.
- If you are refunding an overpayment for multiple claims, you may attach a listing of the individual claim details so that you do not have to complete a new form for each claim. Remember to include all of the data elements listed on the voluntary refund form in the claim listing.
- Voluntary refunds for Medicare Secondary Payer (MSP) situations must include a copy of the primary insurer's Explanation of Benefits (EOB) to ensure proper processing
- Separate voluntary refund forms are available for MSP and non-MSP situations to ensure sufficient information is received to process the voluntary refund
- If for some reason you do not have a primary EOB to submit, please submit use the Medicare Secondary Payer (MSP) explanation form along with the MSP voluntary refund form
- All claims adjusted as a result of the voluntary refund request will be reflected on the Medicare Remittance Advice
- Voluntary refunds cannot be collected via an immediate offset request. Payment must be submitted with a voluntary refund.
- To ensure accurate and timely processing, please avoid handwritten information when completing the form
Links to Refund Forms
Voluntary Refunds with payment:
- Non-MSP Voluntary Refund Form (PDF, 658 KB)
- MSP Voluntary Refund Form (PDF, 540 KB)
- MSP Explanation Form (PDF, 613 KB)
Overpayment Disclosure without payment:
- Reopening: Simple Claim Correction Form (PDF, 447 KB)
- Medicare Secondary Payer Inquiry Form (PDF, 586 KB)
CMS Regulation References