I Received a Demand Letter for an Overpayment

If you have received an "intent to refer" letter and are unable to locate the associated first demand letter, you may request a copy.

Providers have the option to submit payment for any overpayment determined by Medicare. Providers are strongly encouraged to submit electronic payments through eCheck, but may still mail a hard copy check.

 

A provider can elect to waive the standard grace days before offset begins on their overpayment and request immediate offset. The benefit of this option is that it can reduce or eliminate the amount of interest assessed. If recoupment of the overpayment is satisfied within 30 days, no interest is charged. If a balance remains outstanding after 30 days, interest will be assessed on the outstanding balance for each 30 day period where a balance remains outstanding on the overpayment.

A provider may submit a rebuttal statement within 15 calendar days from the date of the demand letter. Your rebuttal statement must include an explanation or evidence to show why recoupment should not be initiated. A rebuttal submission is not considered an appeal and therefore does not stop recoupment upon receipt or while the request is reviewed. A rebuttal is not intended to review supporting medical documentation or disagreement with the overpayment decision.

If a provider disagrees with an overpayment determination made by Palmetto GBA, CERT, Recovery Auditor or the ZPIC/UPIC, they may dispute the overpayment and stop the recoupment process by submitting a timely and valid appeal request. To ensure recoupment is stopped in a timely fashion, a valid appeal must be received within 30 days of the date of demand letter for redetermination requests or within 60 days of the date of the revised demand letter for reconsideration requests. Please note recoupment does not cease when the appeal is at the ALJ and above level.

This module provides an overview of limitations on the recoupment of Medicare overpayments as outlined in Section 935 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA). 

Providers may need more than 30 days to repay the full amount of an overpayment. Providers have the option to submit a Request For Extended Repayment Schedule (ERS). A complete ERS request should be submitted immediately.