Provider Refunds to Beneficiaries (Rev. 1, 10-01-03)

by  Find-A-Code
July 17th, 2015

In the agreement between CMS and a provider, the provider agrees to refund as promptly as possible any money incorrectly collected from Medicare beneficiaries or from someone on their behalf.

Money incorrectly collected means any amount for covered services that is greater than the amount for which the beneficiary is liable because of the deductible and coinsurance requirements.

Amounts are considered to have been incorrectly collected because the provider believed the beneficiary was not entitled to Medicare benefits but:

• The beneficiary was later determined to have been entitled to Medicare benefits;

• The beneficiary’s entitlement period fell within the time the provider’s agreement with CMS was in effect; and

• Such amounts exceed the beneficiary’s deductible, coinsurance or non covered services liability.

Pub 100-04 Medicare Claims Processing Manual


Provider Refunds to Beneficiaries (Rev. 1, 10-01-03). (2015, July 17). Find-A-Code Articles. Retrieved from

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