Recovery Auditor Inquiries and Solutions - JA DME

Q: When does a supplier receive a demand letter?
A: The Recovery Auditor sends claim processing files to Noridian for processing. Noridian notifies the Recovery Auditor within one business day after the claim has processed and an account receivable (AR) file is set up. The Recovery Auditor has seven days from the date they are notified of the AR to issue the demand letter.

Q: What are the options if a supplier disagrees with the Recovery Auditor decision?
A: View Recovery Auditor Determinations - Agree or Disagree for details.

Q: What are the options when a supplier agrees with the Recovery Auditor decision?
A: View Recovery Auditor Determinations - Agree or Disagree for details. 

Q: How does a supplier appeal a Recovery Auditor denial?
A: Request a Redetermination through Noridian.

Q: How does a supplier know that a claim is a Recovery Auditor adjustment?
A: Remittance advice remark code N432 is used to identify Recovery Auditor adjustments. This code appears on the claim level header detail line of your Medicare remittance advice.

Q: How do suppliers obtain copies of a demand letter?
A: Beginning 1/3/12 Noridian began printing the Recovery Auditor first demand letters. For letters dated prior to 1/3/12, suppliers should contact the Recovery Auditor for copies of the demand letter. For letters dated 1/3/12 and after, suppliers should contact Noridian for a copy of the demand letter.

Q: Why is the Recovery Auditor taking money back on a claim?
A: The Recovery Auditor identifies claim billing issues and requests CMS approval to query those findings and recoup the monies. Noridian does not have any of query criteria that the Recovery Auditor uses to identify overpayments. Any questions in regard to how a query was run and what criteria were used to determine the overpayment need to be directed to the Recovery Auditor.

General Inquiries and Solutions

Q: Which supplier address are the overpayment demand letters mailed to?
A: The overpayment demand letters are mailed to the physical/billing address on file with Medicare.

Q: When does interest start to accrue on overpayments?
A: Interest accrues from the date of the demand letter and is assessed on day 31 if the refund is not made on or before this date. This is simple interest and it is reviewed by CMS on a quarterly basis.

Q: How does a supplier request Noridian to offset the overpayment from the future remittance advices?
A: See "Agree with Recovery Auditor Decision" section of Recovery Auditor Determinations - Agree or Disagree.

Q: When does Noridian start recouping from future remittance advices?
A: Offset of the overpayment will occur on day 41 from the date of the demand letter if we have not received a check or a request for an appeal.

Q: What happens if the refund check does not get to Noridian in time?
A: Noridian processes checks by the postmark date. If the postmark date is before interest is assessed, Noridian will reissue the monies and any interest due back to the supplier.

Q: What does the remittance advice remark code N469 mean?
A: The N469 means this is a 935 overpayment and an overpayment demand letter will be coming in the mail soon.

Q: What do the reason codes mean?
A: CS935 means the initial adjustment has been done and shows the overpayment (this will have the same date as the demand letter), but no monies will have been recouped. WO935 means Noridian has recouped the monies from that remittance advice.

Q: How does as supplier keep track of where and when the overpayment is applied?
A: It is suggested that suppliers create a spreadsheet for the tracking of these situations. The spreadsheet should include the following columns in order to track the overpayment. Date of Overpayment (Letter or Remit), Patient Medicare Number, Date of Service, Amount of Overpayment, Date Overpayment applied (date of remittance advice or check sent), Check or Remittance Advice Number, and Interest Applied.