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.

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Last Updated Jan 24, 2020