Recovery Audit Contractor (RAC) Informational Letter Versus Demand Letter - Appeals Newsletter Part 13

This information explains the difference between RAC’s Information Letter versus Noridian’s Demand Letter. The RAC identifies potential Medicare overpayment, and they inform providers through an Informational Letter. RAC communicates with local Medicare Administrator Contractors (MACs) their findings and issues the provider a Demand Letter.

Informational letter:

  • RAC logo on the top right
  • Notification of needed steps to have an open discussion with RAC claim findings
  • Providers and facilities have 30 days from your Informational letter date to request a RAC discussion
  • If there is no provider response, RAC will identify your claim as improper and report it to the local MAC
  • MAC issues a Demand Letter outlining your appeal rights and repayment options
  • Letter not subject to appeal

Demand letter:

  • Informs provider of an improper Medicare payment
  • Requests monies to be paid back
  • Recovery Audit Program review result
  • Allows 15 days to submit rebuttal, per the Code of Federal Regulations (CFR)
  • Instructions for rebuttal and recoupment included in Initial Request Letter
  • Providers may appeal

Resources

Last Updated Feb 05 , 2025