decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Medicare_Financial_Management_Manual / Chapter_4 / 50.3
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Article Overview
This article from the Medicare Financial Management Manual describes how Medicare contractors review and route extended repayment plan requests, including requests of different durations and requests needing additional approval. It is relevant to Medicare administrative, provider finance, and reimbursement staff who handle overpayment recovery and repayment planning. The section also includes a protocol checklist and sample financial exhibits used to organize the required financial review materials.
Why This Topic Matters
It helps readers understand the administrative workflow and documentation framework used in evaluating Medicare repayment arrangements for provider overpayments.
Article Sections
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Approval Process
Overview of contractor review, approval, denial, and referral steps for extended repayment plan requests, including timing and notification responsibilities.
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Requirements to be Completed before approval or denial
Checklist-style requirements that must be reviewed before a repayment plan request can be approved or denied.
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ERP request 12 months or less
Criteria category for repayment plan requests within a shorter duration range.
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ERP request greater than 12 months
Criteria category for longer repayment plan requests that require additional review and routing.
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ERP request asking for an unconventional payment arrangement
Criteria category for repayment requests involving nonstandard payment arrangements.
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ERP Protocol
Protocol checklist and review workflow for evaluating an extended repayment plan request and related financial information.
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Exhibit 1 - Protocol for Reviewing Extended Repayment Plan (ERP) - Provider/Physician Medicare Overpayments
Template form and review fields used to document the repayment plan evaluation process.
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Exhibit 2 - Statement of Source and Application of Funds Period Covered
Financial statement format showing sources and uses of funds for a covered period.
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Exhibit 3, Cash Flow Statement Period Covered
Cash flow statement format used in the financial review of repayment plan requests.
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Exhibit 4, Projected Cash Flow Statement Cash From Operations (Schedule A) Period Covered
Projected cash flow schedule used to support the financial assessment portion of the review.
What You Will Learn
- How Medicare contractors review extended repayment plan requests.
- What categories of financial documentation are reviewed during the process.
- How requests may be handled when additional approval is required.
- What kinds of worksheets and exhibits support the repayment plan evaluation.
Who Should Read This
- Medicare contractors
- Provider reimbursement staff
- Healthcare finance staff
- Revenue cycle professionals
- Compliance and billing personnel
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