Limitation on Recoupment - JE Part B
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.
|Overpayments Subject to Limitation on Recoupment||Overpayments Not Subject to Limitation on Recoupment|
Request a Redetermination
|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|
- 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
- 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
- Submit completed form and copy of provider demand letter to correct "Overpayment Redetermination" address/fax number included within 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.
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.
- 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
Last Updated Wed, 26 May 2021 17:31:27 +0000