Submit a Voluntary Refund

A voluntary refund should be returned to Medicare any time an overpayment has been identified by a provider. Overpayments are Medicare funds that a provider, physician/supplier or beneficiary has received in excess of amounts due and payable by Medicare. Once a determination of overpayment has been made, the amount is a debt owed to the United States Government.

When you identify an overpayment
Part A and home health and hospice providers are encouraged to submit their own adjustments to correct their claims. This will set up the overpayment and offset the funds due Medicare from the next claim payment.

If the provider is not able to submit their own adjustments, the appropriate voluntary refund form and payment should be submitted.

How to submit a voluntary refund
Providers are strongly encouraged to submit Voluntary Refunds electronically using the eCheck feature within the Financial Tools section of Palmetto GBA’s eServices. The eCheck function allows payments to be sent electronically to Palmetto GBA. Voluntary refunds can be submitted by using the eCheck option and selecting the option within the eCheck form indicating the payment is not associated with a demand letter. A copy of the voluntary refund form and any other relevant documents must be uploaded and attached to the eCheck to assist in processing. Once submitted, you will receive a confirmation from Palmetto GBA indicating that the payment has been received.  For more information, please review the Financial Tools Section in the eServices user manual (PDF, 7.85 MB).

Providers may also mail a check payable to Palmetto GBA or Medicare, the completed applicable Voluntary Refund form, and any relevant documentation to the address listed at the bottom of the applicable Voluntary Refund form.

Additional information

  • If you are refunding an overpayment for multiple claims, you may attach a listing of the individual claim details so that you do not have to complete a new form for each claim. Remember to include all of the data elements listed on the voluntary refund form in the claim listing.
  • Part A and Part B voluntary refunds should be submitted separately with the corresponding Voluntary Refund form to ensure proper processing
  • Voluntary Refunds for Medicare Secondary Payer (MSP) situations must include a copy of the primary insurers Explanation of Benefits (EOB) to ensure proper processing 
    • Separate Voluntary Refund forms are available for MSP and non-MSP situations to ensure sufficient information is received to process the voluntary refund
  • All claims adjusted as a result of the voluntary refund request will be reflected on the Medicare Remittance Advice
  • Voluntary Refunds cannot be collected via an immediate offset request. Payment must be submitted with a voluntary refund.
  • To ensure accurate and timely processing, please avoid handwritten information when completing the form

Please see the form link(s) below

CMS Regulation References

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

Email Part A

Contact a specific JM Part A department

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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