Tools & forms: Overpayments
Tools
Appeal Status
Appeal Timeliness 
Reopening Gateway (B) Forms
Providers, participating physicians, and other suppliers may occasionally receive improper payments based on Medicare regulations. Once an overpayment has been identified, any excess amount is considered a debt owed to Medicare and must be paid upon receipt of an overpayment notice.
First Coast has revised the Return of Monies Voluntary Refund and Extended Repayment Schedule (ERS) Request forms, used for overpayments. Please use the following forms for accurate submission and mailing information.
| Form | Description |
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Report an overpayment Complete an overpayment refund form to notify First Coast of an overpayment prior to receiving a demand letter |
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Request immediate recoupment Have overpayments immediately offset as funds become available. This process is a convenient and cost effective way to pay demanded debt. |
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Dispute To dispute an overpayment identified in a demand letter use the appropriate overpayment redetermination, non-Medicare secondary payer (MSP) or MSP request forms listed. |
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Extended repayment schedule (ERS) If you are experiencing financial difficulties in repaying debt, an extended repayment schedule may be considered. Complete the appropriate form along with all supporting documentation |