September 17, 2008
Limitation on recoupment for provider, physician, and supplier overpayments
Effective Date: September 29, 2008
Implementation Date: September 29, 2008
Summary
Before the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) was enacted, a provider’s electing to appeal an overpayment determination did not affect Medicare’s prerogative to recover the debt. However, through an amendment of title XVIII of the Social Security Act (the Act); MMA section 935 changed this process, by adding a new paragraph (f) to section 1893 of the Act.
This amendment requires the Centers for Medicare & Medicaid Services (CMS) to change both of the following:
1. the way it recoups certain overpayments
2. how it pays interest when the overpayment is reversed at subsequent administrative (administrative law judge [ALJ]) or judicial levels of appeal
It requires that when a valid first or second level appeal is received from a provider on an overpayment, subject to certain limitations, CMS and its contractors may not recoup the overpayment until the decision on the redetermination and/or reconsideration has been rendered.
The rebuttal process
You are given an opportunity to rebut any proposed recoupment action submitting a statement within 15 days of the notice of an impending recoupment action. These rebuttal procedures occur prior to the appeals process and are separate from the requirements of the limitation on recoupment.
Additional information is available on the CMS Web site. Here is the link to the MLN Matters article MM6183 
.
.Source: CMS MLN Matters Article MM6183
