Refund of payment to the Patient

Where the patient is not responsible for the payment of a service, the physician must refund any monies previously collected from the patient. If the physician does not refund the monies within the specified time limits, the following actions may occur: 

Assigned claims – The patient may submit a request to Medicare for indemnification from payment. A letter is sent to the physician stating that a refund must be made within 15 days. The re- fund must be for the amount actually paid to the physician, including any amounts applied to the deductible or coinsurance. If a refund is not made within 15 days, Medicare will pay the patient and request a refund from the physician for the amount paid. 

Nonassigned claims – The patient may notify Medicare that the physician did not refund the amount due. Medicare contacts the physician to explain that a refund is due to the patient. If a re- fund is not made within 15 days, the physician may be subject to civil monetary penalties and sanctions.

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