Recovery Auditor Determinations - Agree or Disagree - JD DME
Recovery Auditor Determinations - Agree or Disagree
Recovery Auditor Demand Letter
Agree with Recovery Auditor Decision
Disagree with Recovery Auditor Decision
Recovery Auditor redeterminations follow the normal Medicare appeals process. If a supplier has received a demand letter identifying an overpayment from a Medicare Recovery Auditor and believes it is incorrect, the decision may be appealed. It is important to understand the deadlines that exist at all the levels of appeal.
Below are the steps suppliers should take.
- Recoupment(s) Halted: When a supplier submits a Redetermination within 30 days of receiving a demand letter identifying an overpayment from a Recovery Auditor
- Interest Accrues: With or without a Redetermination 31 days from date supplier receives overpayment letter, unless full repayment is made before this time
- Time Limit to File Initial Redetermination: 120 days (from overpayment determination date)
- Redetermination Elements Required: The following elements must be present when requesting a Redetermination: beneficiary(s) name; Medicare Health Insurance Claim Number(s) of beneficiary(s); specific service(s) and/or item(s) for which Redetermination is being requested; specific date(s) of service; and name and signature of person filing Redetermination request
- Documentation: When submitting a redetermination, include all relevant medical documentation to support appeal
If suppliers have not done so already, update contact information with the Recovery Auditor. This will assist receiving requests for documentation timely.
Please be aware the DME Supplier Contact Center can only answer general question about the Recovery Auditor program. Any other questions should be directed to the Recovery Auditor contractor.
Last Updated Tue, 24 Jul 2018 09:33:29 +0000