Once an overpayment has been determined, providers are required to repay the debt. Complete the overpayment refund form (see below) and attach a check for the amount. Specific data such as patient name, Medicare ID # and Medicare claim number must be included for claim correction and remittance revision, where appeal rights are afforded. If this data is not returned and Medicare is unable to correct records, claim(s) included in the refund may be identified as an overpayment and demanded in the future.

• Return of monies voluntary refund form

Reference

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//fin106c05.pdf