The Rebuttal Process and the Limitation on Recoupment

200.1.4 – The Rebuttal Process and the Limitation on Recoupment (Rev. 293, Issued: 09-14-17, Effective: 04-02-18, Implementation: 04-02-18) In 42 CFR 405.373 through 405.375, regulations require that providers be given an opportunity to rebut before recoupment takes effect. The provider can submit a statement that includes any pertinent information as to why recoupment should not be put into effect on the date specified in the notice/demand letter within 15 days. The rebuttal process is not an appeal. A rebuttal permits the provider a vehicle to indicate why the proposed recoupment should not take place. The contractor may, based on the rebuttal statement, determine to stop recoupment or proceed with recoupment. In contrast, the limitation on recoupment provision mandates that no recoupment begins when a valid and timely request for a first level or second level appeal is received. Refer to Publication 100.08, Medicare Program Integrity Manual, Chapter 3, Verifying Potential Errors and Taking Corrective Actions, § 3.6.5 - Provider Financial Rebuttal of Findings