Recoupment After the Initial Demand: When Does it Begin?

200.2.2 - Recoupment After the Initial Demand: When Does it Begin? (Rev. 311, Issued: 02-22-19, Effective: 10-07-19, Implementation: 10-07-19) Timeframe Medicare Contractor Provider Day 1 Send demand letter. Receives notification by first class mail of overpayment determination. (The letter date is the determination date). Day 1-15 Process rebuttal requests received before or by day 15 deadline. No recoupment occurs. Can submit a rebuttal request within 15 days from the date on the demand letter. (The letter date is the determination date). Can request an Immediate recoupment Day 16-30 Process rebuttal requests received before or by day 15. Performs administrative activity (i.e., validating Redeterminations and updating account receivables to the Redetermination status). No recoupment occurs unless the provider requested the Immediate Recoupment Can request a redetermination and potentially prevent any recoupment from occurring on day 41. Day 31-40 Performs administrative activity (i.e. validating Redeterminations and updating account receivables to the Redetermination status). No recoupment occurs unless the provider requested the Immediate Recoupment. Can request a redetermination and potentially prevent any recoupment from occurring. Day 41 Recoupment begins on overpayments without a validate redetermination request. Can request a redetermination and potentially stop recoupment from continuing. 1. Recoupment shall proceed on day 41 (with the exception of immediate recoupment) from the initial demand letter without a timely and valid request for a redetermination. 2. To prevent recoupment from occurring on day 41, the provider must file the request for a redetermination no later than the 30th calendar day following the date of the initial demand letter. 3. Contractors shall refer to Publication 100-04 Medicare Claims Processing Manual, Chapter 29, and Appeals of Claims Decision, to determine what constitutes a valid request for a redetermination. 4. Contractors shall have internal controls in place to ensure when a provider is in an immediate recoupment status the recoupment process continues unless a request from the provider is received to stop the immediate recoupment. 5. Contractors shall continue to stop recoupment on or after day 41 from the demand letter date when the appeal request is received and validated with an outstanding balance. • Providers have 120 days after the date of receipt of the initial determination (the notice of initial determination is presumed to be received 5 days after the date of the notice unless there is evidence to the contrary) to request a redetermination in accordance with Publication 100.04, Chapter 29