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Last Modified: 12/22/2017 Location: FL, PR, USVI Business: Part B

What if an MSP refund is not made at the time the provider notifies Medicare of the duplicate primary payment?

Q. What if an MSP refund is not made at the time the provider notifies Medicare of the duplicate primary payment (DPP)?
A. Providers are required to pay Medicare within 60 days from the date a payment is received from another payer (primary to Medicare) for the same service for which Medicare paid.
However, if a demand letter is needed by the provider’s accounting department, submit the MSP Overpayment Refund form and the other insurer’s EOB and/or payment information (e.g., a copy of the check) to Medicare.
If the other insurer’s EOB is not received or information does not match all the detail line on the Medicare claim, the entire claim and/or detail line will be processed as a full denial. This could result in a balance due to Medicare, demandable debt with no Medicare Secondary consideration.
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