Overpayments and Next Steps
When Medicare (Noridian) or other outside contractor, such as the Recovery Audit Contractor (RAC), has determined that an overpayment has occurred, a Demand Letter is issued.
When a demand letter is received, providers have the following options:
Agree with the Overpayment:
- Send Noridian a check for the owed money
- Request an Immediate Recoupment
Disagree with the Overpayment
- Submit a Rebuttal if the overpayment action will cause financial hardship (A rebuttal will not stop the recoupment activities)
- Submit a Redetermination Request
When a provider disagrees with the demand letter, submit a Redetermination Request for the original claim or the newly adjusted claim on which the take-back was completed. Please do not submit new claims. This may cause a delay in processing the overpayment, create a claim denied due to timely filing because it was not submitted within one year of the date of service, or create a duplicate denial.
For RAC reviewed claims, once an informational or review results letter is received, the provider may file a discussion period request with the RAC. This may be the best time to request adding new and/or replacement procedure codes. This must be submitted within 30 days from the date of the letter. The informational or review results letter is received prior to the Demand Letter.
Last Updated Jan 24, 2020