CMS Pub. 100-06, ch. 3, § 200.1.2

A. All other MSP overpayments that aren’t identified in § 200.1.1 above.

B. Beneficiary overpayments

C. Cost report overpayments

D. HHA Request for Anticipated Payment (RAP) (refer to 200.1.1 (D) for exceptions).

Note: This is not considered a claim for purposes of Medicare appeals regulations; however, it is

submitted using the same format as Medicare claims. RAPs under the Home Health Prospective

Payment System (HH PPS) do not have appeal rights during (1) the 120 days from the start of

the episode; or (2) 60 days from the payment date of the RAP to submit the final claim;

rather, appeals

rights are tied to the claims that represent all services delivered for the entire HH PPS

episode (refer to Publication 100-04 Medicare Claims Processing Manual, Chapter 10, §§10.1.10

through 10.1.12,

40.1 & 50).

E. Hospice Caps calculations

F. Provider initiated claim adjustments (including MSP DPP provider initiated adjustments)

G. Accelerated/Advanced Payments

H. Reopening of claims (Clerical errors and mass adjustments)

I. Periodic Interim Payment (PIP) rate adjustments (with the exception of a RAC claim

review, which determines an overpayment)

J. Payment Suspensions