Immediate Recoupment for Fee for Service Claims Overpayments

Good Morning MFS Bloggers, Effective July 1, 2012, CMS Change Request (CR) 7688 implements a standard 'immediate recoupment' process that gives providers the option to avoid interest from accruing on claims overpayments when the debt is recouped in full prior to or by the 30th day from the initial demand letter date.

Background
Currently, Medicare Contractors begin recoupment of an overpayment on day 41 from the date of the initial demand letter. Interest accrues and assesses on an overpayment if not paid in full by day 30.

Key Points
The 'immediate recoupment' process implemented in CR 7688 allows providers to request that recoupment begin prior to day 41. Providers who elect this option may avoid paying interest if the overpayment is recouped in full prior to day 31.
Key to understanding this change is that providers who request an immediate recoupment must realize it is considered a voluntary repayment. Also, note the following:
1. Providers who choose immediate recoupment must do so in writing to the contractors
2. The request may be for:
• A one-time request for a specific demanded overpayment (the total amount of the demanded overpayment). A permanent request for the specific demanded overpayment and all future overpayments
3. The request may be submitted via regular mail, fax or e-mail and the request must include the Provider's name, contact phone number, Medicare number and/or National Provider Identifier (NPI), Provider or Chief Financial Officer's signature, demand letter number and what option the provider is requesting
4. By choosing immediate recoupment, providers must understand that they are waiving their rights to interest under Section 935 of the Medicare Modernization Act (MMA) should the overpayment be reversed at the Administration Law Judge level (AU) or subsequent higher levels
5. Providers can terminate the immediate recoupment process at anytime. The request to terminate must be in writing.

Providers should note that Medicare Contractors will not consider any recoupment after Qualified Independent Contractor (QIC) proceedings (30 days after a QIC decision) as voluntary payments. Medicare Contractors will follow the rules proscribed by Section 935 of the MMA for all recoupment activity after a QIC decision. These rules are explained in Chapter 3, Section 200 of the Medicare Financial Management Manual that is available at www.cms.gov/manuals/downloads/fin106c03.pdf on the Centers for Medicare & Medicaid Services (CMS) Web site