- Recovery Audit Contractor (RAC)
- Program Safeguard Contractor (PSC)
- Office of Inspector General (OIG) determined overpayments
- Comprehensive Error Rate Testing (CERT)
- Supplemental Medicare Review Contractors (SMRC)
- Unified Program Integrity Contractor (UPIC)
Overpayments Not Subject to Limitation on Recoupment
- All other Medicare Secondary Payer recoveries except those identified above
- Beneficiary overpayments
- Overpayments that arise from a cost report determination
- HHA Request for Anticipated Payment (RAP)
- Hospice Caps calculations
- Provider initiated adjustments
- Accelerated/Advance Payments
- Reopening of claims (Clerical errors and mass adjustments)
- Periodic Interim Payments (PIP) rate adjustments (except for a RAC claim review, which determines and creates an overpayment)
- Payment Suspensions
Request a Redetermination
| Timeframe | Provider/Supplier Action | Recoupment |
|---|---|---|
| Day 1 | Receives notification via mail of overpayment determination | N/A |
| Day 1-15 | Must submit rebuttal request within 15 days from demand letter date | Collection does not occur |
| Day 1-40 | May appeal and potentially limit recoupment from occurring | Collection does not occur |
| Day 41 | May appeal and potentially stop recoupment | Unless a valid appeal is received, collection begins |
Electronic Submission
- Submit via NMP. It's fast, secure and economical - Log In Now
- Access educational resources, learn how to register, and view user manual on NMP webpage
Paper Submission
- Access Redetermination Form - One request form per beneficiary and issue
- Complete all form fields. An incomplete request is counted as a dismissal
- Be sure to check "Overpayment Redetermination" box in "Types of Request" section of form
See the Redetermination webpage for additional first level of an appeal related details
Request a Reconsideration
Unless a reconsideration is filed with the Qualified Independent Contractor (QIC), payment is made in full or a valid extended repayment schedule (ERS) has been received, collection process will continue on any existing debt within 60 days of the Redetermination notice.
Interest will continue to accrue as of the demand letter date.
See the Reconsideration webpage for additional second level of an appeal related details.
Immediate Recoupment
Medicare allows providers to sign up for Immediate Recoupment, a process which allows overpayments to be automatically recouped from currently processed and paid claims. View the Immediate Recoupment webpage for details.
Resources
- CMS Internet Only Manual (IOM), Publication 100-06, Medicare Financial Management Manual, Chapter 3
- CMS Change Request (CR) 6183: Limitation on Recoupment (935) for Provider, Physicians and Suppliers Overpayment
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