Limitation on Recoupment - JA DME
Limitation on Recoupment
Section 1893 (f)(2)(a) of the Social Security Act provides limitations on the recoupment of Medicare overpayments.
Noridian will stop all recoupment activities:
- Upon the receipt of a valid and timely redetermination or reconsideration request
- However, collection activities will continue if a valid appeal is filed to the Administrative Law Judge, Medicare Appeals Council, or Federal court
- Both principal and interest collected on the overpayment will be refunded for any overturned appeal decisions
- However, collection activities will continue if a valid appeal is filed to the Administrative Law Judge, Medicare Appeals Council, or Federal court
Overpayments Subject to Limitation on Recoupment
- Post Pay Denials of claims
- Recovery Audit Contractor (RAC)
- Office of Inspector General (OIG) determined overpayments
- Comprehensive Error Rate Testing (CERT)
- Supplemental Medicare Review Contractors (SMRC)
- Unified Program Integrity Contractor (UPIC)
- Medicare Secondary Payer (MSP) Duplicate Primary Payment (DPP)
- MSP recovery due to provider's failure to file a proper claim with third-party payer plan, program, or insurer for payment
Overpayments Not Subject to Limitation on Recoupment
- All other Medicare Secondary Payer recoveries except those identified above
- Beneficiary overpayments
- 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 (Resolving Overpayment)
| 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 the inquiry guide on the Noridian Medicare Portal (NMP) for self-service reopening (DME Recoupment Requests)
Paper Submission
- Access Medicare DME Redetermination Request Form or CMS-20027 Medicare Redetermination Request Form. One request form per beneficiary and claim control number (CCN)
- Complete all form fields. An incomplete request will be dismissed
- Be sure to check "Yes" in Overpayment Appeal section of "Medicare DME Redetermination Request Form" or "Does this appeal involve and overpayment?" box in CMS-20027 "Medicare DME Redetermination Request Form"
- Submit completed form and copy of supplier demand letter to correct address/fax number
- See form for fax number or Mailing Addresses webpage for "Overpayment Redetermination and Rebuttal Requests" postal address
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 suppliers 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 or Offset webpage for details.
