Reconciling Refund Amounts to Patient Accounts

Published 01/04/2021

In an effort to address provider questions regarding refunds received from Palmetto GBA and reconciling these refund amounts to patient account activity, Palmetto GBA has implemented a refund notification process. When a refund is issued to a provider, Palmetto GBA will send out a standard refund notification letter. This letter will contain the following information:

  • Refund amount (principal and interest)
  • Patient information (beneficiary name and dates of service)
  • Remittance advice (RA) — date on which refund was included
  • Refund reason (e.g., Appeal – Favorable Decision, RAC – Partially Favorable Decision, Reopening – Dismissed Decision)
  • AR/overpayment number

Within five to seven business days of the remittance advice date, the standard refund notification letter will be sent to the provider. It is our hope that this additional information will assist providers in reconciling payment activity to patient account activity and reduce the need to call the Provider Contact Center (PCC) to assist with reconciling refund amounts.

In addition to the standard refund notification letter, Palmetto GBA has enabled our Interactive Voice Response (IVR) system to allow providers to look up and retrieve the FISS claim number associated with the Accounts Receivable (AR)/Overpayment Number supplied on the standard refund notification letter. Please reference the IVR Information on the Palmetto GBA website.

An example of the new standard refund notification letter is listed below:

Provider Number: 11001-xxxxxx-xxxxxxxxxx

Refund Invoice Number: 123456789

Dear Sir or Madam:

This is to inform you of a refund issued to your provider. The details concerning this refund are listed as follows:

  • Refund Invoice Number: 123456789
  • Refund Amount: $123.45
  • Check Date: xx/xx/xxxx
  • Refund Reason: RAC – Favorable Decision Reconsideration

Please note: The refund amount listed above was subject to offset against any outstanding overpayments, therefore the final check amount may not reflect the full refund amount determined.

This refund was determined as a result of activity related to the following Medicare overpayment:

  • Overpayment Number: 123456789123456789
  • Beneficiary Name: John Smith
  • Beneficiary Dates of Service: xx/xx/xxxx – xx/xx/xxxx

Please retain a copy of this notification letter for your records.


Finance & Accounting

Was this article helpful?