Recovery Auditor Determinations - Agree or Disagree

Agree with Recovery Auditor Decision

  • Send Request for Immediate Recoupment Form to Noridian
  • Either mail check to the Contractor (Noridian) or
  • Allow offset on Day 41 (interest accrues 31 days from date of demand letter)

Disagree with Recovery Auditor Decision

  Discussion Period Rebuttal Redetermination
Which option should I use?
  • Offers opportunity for providers to provide additional information to the Recovery Auditor to indicate why recoupment should not be initiated
  • Offers opportunity for the Recovery Auditor to explain rationale for overpayment decision
  • After reviewing the additional documentation submitted the Recovery Auditor could decide to reverse the decision
  • A letter will go to the provider detailing the outcome of the discussion period
  • Should be submitted only on rare occasions of financial hardship
  • Process allows providers the opportunity to provide a statement and accompanying evidence indicating why overpayment action will cause a financial hardship and should not take place
  • Not intended to review supporting medical documentation nor disagreement with overpayment decision
  • Should not duplicate redetermination process
  • Noridian will provide a decision in writing within 15 days of the rebuttal request. However, the rebuttal statement is not an appeal of the overpayment determination, and it will not delay/cease recoupment activities
  • Recovery Auditor redeterminations follow the standard Medicare appeals process
  • Submitted Appeal when provider has received a demand letter identifying an overpayment from the Recovery Auditor and provider believe it is incorrect.
  • Include all documentation to support appeal
Who do I contact? Recovery Auditor Noridian Noridian
Timeframe Day 1-30 Day 1-15 Day 1-120
  • Must be submitted within 120 days of receipt of demand letter
  • Must be filed within 30 days to prevent offset on day 41
Timeframe Begins Date of Demand Letter Upon receipt of Demand Letter
Timeframe Ends Day 40
  • Offset begins on day 41
 Day 15 Day 120

 

Last Updated Dec 09 , 2023