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Last Modified: 4/21/2011
Location: FL, PR, USVI
Business: Part A, Part B
Limitation on recoupment (935) process
Contractor timelines and audit explanations
The information below outlines the process for the 935 recoupment due to changes from the Centers for Medicare & Medicaid Services (CMS) through change request (CR) 6183 -- limitation on recoupment of section 935 for provider, physicians and suppliers overpayments.
Contractor’s recoupment timeline
Timeframe |
Contractor action |
|---|---|
Day 1 |
Date demand letter mailed |
Day 1-15 |
Rebuttal submission deadline • A rebuttal request may/may not stop a debt from being collected. Only a valid and timely request for redetermination will stop the collection. |
Day 1-30 |
Submit refund payment in full, or request a valid appeal • No interest accrued |
Day 31 |
Interest accruement begins • Accruement continues until debt is fully satisfied. Fully satisfied means paid in full or overturned by appeal. |
Day 1-40 |
No recoupment occurs |
Day 41 |
Recoupment begins • Unless an appeal is in process |
General notes
• Providers have 15 days to rebut any proposed recoupment
• To stop recoupment, providers may either pay the recoupment in full, or file a redetermination appeal or reconsideration
• An administrative law judge (ALJ) request will not stop recoupment
A redetermination can have three possible outcomes:
1. Favorable
2. Unfavorable
3. Partially favorable
After receiving a valid request for a redetermination appeal, the contractor will:
1. Stop recoupments subject to appeal,
2. Retain any overpayments previously collected and apply first to the interest and then to the principal of any other debt provider may owe, and
3. Continue to collect on any other debt owed by provider, but will not withhold monies related to the current debt while it is in an appeal status.
Recoupment will begin on the 41st day if one of the following three actions do not occur:
1. Payment is not made in full,
2. An extended repayment schedule is not requested, and
3. A redetermination or reconsideration is not made within the appropriate timeframe.
Appeals process
Click here to access an outline of the appeals process.
• Note: The redetermination process can begin anytime from day 1 to day 120. After 120 days, an appeal will not be accepted.
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