Opportunity to Submit Additional Information Before

8.2.3.3.2 - Opportunity to Submit Additional Information Before Consent Settlement Offer (Rev. 377, Issued: 05-27-11, Effective: 06-28-11, Implementation: 06-28-11) The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, section 935(a)(5) states the provider has the opportunity to submit additional information before being offered a consent settlement. Based on a postpayment review of the medical records, the contractor shall communicate in writing to the provider or supplier that: • The preliminary evaluation of the records indicates there would be an overpayment; • The nature of the problems in the billing and practice patterns identified in the evaluation; • The steps that the provider or supplier can take to address the problems; and • The provider or supplier has forty-five (45) days to furnish additional information concerning the medical records for the claims that have been reviewed. If after forty-five (45) days, it is determined that there is still an overpayment, then the provider or supplier shall receive a consent settlement offer. If an overpayment is not warranted after additional review, then a follow-up letter shall be sent to the provider or supplier stating that no additional action is deemed necessary.