Overpayment Assessment Procedures

8.2.1 – Overpayment Assessment Procedures (Rev. 670, Issued: 08-19-16, Effective: 11-23-16, Implementation: 11-23-16) After an overpayment determination is made concluding an incorrect amount of money has been paid, contractors must assess an overpayment. The assessment options vary depending upon the type of sample used when identifying beneficiary claims for inclusion in the postpayment review. Whenever possible, CMS encourages contractors to report postpayment savings in terms of: • Actual overpayment; • Settlement based overpayment, or • Extrapolated overpayments. A. Example Format of An Overpayment Worksheet (also see Exhibit 46) Provider/Supplier Name Provider/Supplier National Provider Identification Number (NPI) or Provider Transaction Access Number (PTAN) Reason for Review Type of Sample Reviewed: Statistical Sampling for Overpayment Estimation Explanation of Sampling Methodology: Number of Claims in Sample Number of Claims in Universe Amount of Overpayment (after allowance for deductible and coinsurance) Claims Reviewed Billed Amount Allowed Amount Rationale for Denial §1879 Determinations §1870 Determinations Total Actual Overpayment Overpayment extrapolated over the universe