Requesting an Extended Repayment Schedule (ERS)

Overpayments are Medicare funds 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. Overpayments must be repaid as quickly as possible.

If the total overpayment amount cannot be repaid within 30 days after receiving the first demand letter, providers should request an ERS. A written request must be submitted that refers to the specific overpayment. The request must detail the number of months requested, indicate the monthly payment amount, and include the first payment.

• You must explain and document your need for an ERS
• A repayment plan may be established to recover all or part of an overpayment
• You must continue to make proposed monthly payments while the request is being considered

To apply for an ERS, you must submit the completed Extended Repayment Schedule form and all required documentation. Please access the link at the bottom of this page to review and complete the Extended Repayment Schedule form.

Sole proprietors will also need to complete and mail Form CMS 379 — Financial Statement of Debtor (PDF, 180 KB). All of the requested information must be submitted before the overpayment can be removed from withholding. If an incomplete request is submitted, the recoupment of the overpayment will continue until the request is completed or the overpayment is fully recouped.

Providers are encouraged to submit electronic payments and attach the ERS Request and supporting documentation using eCheck via Palmetto GBA's eServices. Providers can electronically submit payment, the ERS request and PDF attachments online. Once submitted, you will receive a confirmation from Palmetto GBA indicating that the payment and attachments have been received. For more information, please review the Financial Tools Section in the eServices user manual (PDF, 8.25 MB).

Links to Refund Forms

• Request for Extended Repayment Schedule Form (PDF, 210 KB)
• CMS 379 - Financial Statement of Debtor (PDF, 180 KB)

CMS Regulation Reference: Publication 100-06, Chapter 4, Section 50 (PDF, 1.10 MB).