Satisfy an Overpayment
User Roles:
This section provides information about the following topics regarding overpayments:
- Introduction to RDS Overpayments
- Timing for Satisfying Overpayments
- User Role Responsibilities for Satisfying an Overpayment
- Communication About Overpayments
- Send an Overpayment Remittance
- Offsetting an Overpayment With a Positive Payment Request on Another Application
- Consequences of Not Satisfying an Overpayment
Introduction to RDS Overpayments
At Reconciliation, an overpayment may exist on an application for the following reasons: the sum of previous payment request(s) exceeds the current subsidy amount based on the most recent Allowable Retiree Costs and/or the Mandatory Payment Reduction.
In addition, if a Plan Sponsor fails to meet the Reconciliation Deadline for an application and has received interim payments, the sum of those payments will become overpayments.
When there is an overpayment, CMS will initiate immediate overpayment recovery action.
Review an Overpayment
If there is an overpayment, the Reconciliation: Review and Submit page will display the Amount of Reconciliation Payment Request as a negative number in red font in parentheses.
The Review Subsidy table displays the cumulative Net Total in the Subsidy Amount column for the entire application. If there is an overpayment, the Net Subsidy Amount will display as a negative number in red font in parentheses.
The Benefit Option Summary table displays the Net Subsidy Amount for each Benefit Option in the application. If there is an overpayment, the Net Subsidy Amount will display as a negative number in red font in parentheses.
The Amount of Reconciliation Payment Request and the Net Subsidy Amount will be the same.
Timing for Satisfying Overpayments
When the Reconciliation Determination for an application is made, CMS' RDS Center will send an Overpayment Notification Email stating that a balance is due.
Payment is due immediately upon receipt of the Overpayment Notification Email.
Note: An overpayment remittance may be sent to CMS' RDS Center as soon as the overpayment notification is received.
User Role Responsibilities for Satisfying an Overpayment
CMS' RDS Center will send notification emails regarding overpayments to the Plan Sponsor's Authorized Representative, Account Manager, and Designees with the Appeal privilege.
The Plan Sponsor is responsible for satisfying all overpayments that occur.
Communication About Overpayments
CMS' RDS Center may send the following emails regarding overpayments to the Plan Sponsor's Authorized Representative, Account Manager, and Designees with Appeal privileges:
- Overpayment Notification Email - informs the Plan Sponsor that an overpayment has occurred
- Overpayment Notification of Change Email - informs the Plan Sponsor of recent activity for a particular application including updated balance information
- Check Acknowledgement Email - informs the Plan Sponsor that a check or money order was received by CMS' RDS Center
- Refund Notification Email - informs the Plan Sponsor of a refund
Note: Any requests for assistance regarding overpayments should be directed to CMS' RDS Center.
Send an Overpayment Remittance
A Plan Sponsor may submit an overpayment remittance in the form of a check or money order. No other methods of payment will be accepted by CMS' RDS Center.
Make the check or money order payable to: Centers for Medicare & Medicaid Services.
Include the Plan Sponsor ID on the check or money order.
Mail your check or money order to the following address:
Retiree Drug Subsidy Center
6054
P.O. Box 7247
Philadelphia, PA 19170-0000
This address is for overpayment remittance only. No other correspondence received at this address will be considered.
Note: This is the only mailing address for remitting a payment to CMS' RDS Center. However, Plan Sponsors also have the option of sending payments using certified mail through the United States Postal Service (USPS). Federal Express and UPS will not deliver certified mail to a PO Box address.
Overpayment Remittance Acknowledgement
CMS' RDS Center will send a Check Acknowledgement Email to the Authorized Representative and Account Manager to confirm the receipt of the overpayment remittance on the day the check or money order is received.
Offsetting an Overpayment with a Positive Payment Request on Another Application
CMS' RDS Center will deduct an overpayment from any positive interim payment requests or any positive final payment requests on another application with the same Plan Sponsor ID that is available.
If the amount of the positive payment request does not satisfy the entire overpayment, the Plan Sponsor will receive an Overpayment Notification of Change Email for the remaining balance.
If the positive payment request does satisfy the entire overpayment, then CMS' RDS Center will send an Overpayment Notification of Change Email stating that the overpayment is fully satisfied.
Refunding Monies
If an overpayment is offset by a positive payment request on another application, and then an overpayment remittance is received, CMS' RDS Center will refund the monies. The refund payment will be satisfied by Electronic Funds Transfer (EFT) to the account specified on the application. A Refund Notification Email will be sent to the Authorized Representative, Account Manager, and Designee with the Appeal privileges to inform them that the monies have been returned.
Remit Payment Even if You Have Requested an Appeal
If you have received an Overpayment Notification Email and have requested an appeal, you must remit payment. Until an appeal decision is made by CMS' RDS Center, the Overpayment Notification Email is considered the final Reconciliation determination, and payment must be remitted based on such determination.
Request a W-9 Form for Tax Purposes From CMS' RDS Center
Contact CMS' RDS Center to request a W-9 tax form.
CMS' EIN
The Centers for Medicare & Medicaid Services Employer Identification Number (EIN) is 52-0883104.
Consequences of Not Satisfying an Overpayment
Outstanding Overpayments
CMS reserves the right to refer outstanding amounts to the U.S. Department of Treasury for collection.
Assessing Interest on an Overpayment
CMS reserves the right to assess interest on outstanding overpayment amounts. In such cases, Plan Sponsors will be informed before interest is assessed and notified of the interest rate.