Definition of Overpayment Assessment Terms

8.2.1.1 – Definition of Overpayment Assessment Terms (Rev. 670, Issued: 08-19-16, Effective: 11-23-16, Implementation: 11-23-16) A. Actual Overpayment An actual overpayment is, for those claims reviewed, the sum of payments (based on the amount paid to the provider/supplier and Medicare approved amounts) made to a provider/supplier for services which were determined to be medically unnecessary or incorrectly billed. B. Projected Overpayment A projected overpayment is the numeric overpayment obtained by projecting an overpayment from statistical sampling for overpayment estimation to all similar claims in the universe under review.