CMS Pub. 100-06, ch. 3, § 200.4

Subject to Limitation on Recoupment

(Rev. 12261; Issued:09-22-23, Effective: 12-11-23; Implementation: 12-11-23)

The Qualified Independent Contractor (QIC) determines the validity and timeliness of a

request for the reconsideration. To limit recoupment, the request should have a

mailroom receipt date no later than the 60th calendar day from the date of the

redetermination for Unfavorable Determinations or from the Revised Redetermination

Overpayment Demand Letter date.

1. Contractors shall place overpayments in the Reconsideration appeal

status toavoid further recoupments when validated on or after day 60

from the Redetermination decision date or the Redetermination Revised

Overpayment Demand Letter date.

2. Contractors shall recall debts back to its location when the overpayment

was referred to Treasury.

Note: Providers have 180 days from the date of receipt of the redetermination appeal

decision tofile for a reconsideration request in accordance with Chapter 29, Claim appeals,

section 240. Once the appeal is received and validated, Contractors shall update the appeal

status to stop recoupment. When the QIC receives a request for reconsideration, it will

request the case file from the MAC using the Redetermination Case File Request Form in

accordance with Publication 100-04, Medicare Claims Processing Manual Chapter 29 -

Appeals of Claims Decisions.

A. Contractors shall utilize the 15 additional calendar days (between the 61st day

to the 76th day) starting from the redetermination appeal decision date or the

Revised Redetermination Overpayment Demand Letter date to address the listing

below after the case file requests are received.

1. The appropriate unit shall continue to update the list for the overpayment recovery

Unit with Part B case file requests received.

2. Review the MAS for updates on the Part A Reconsideration updates.

3. Update the HIGLAS to the reconsideration appeal status, when appropriate.

4. After the appeal status updates (in HIGLAS), send the Reconsideration Receipt

Notice to the appellant within eight (8) business days.

B. Contractors shall have internal controls in place to avoid recoupment from starting

on day 76.

C. Contractors shall contact the QIC only when it becomes necessary to confirm

receipt of an appeal when notified by the provider and the 76th calendar day is

approaching.

Contractors shall confirm:

1. There is no communication from the QIC for a request of the redetermination

case file for Part B.

2. There is no information in the MAS for Part A.

3. The Provider submitted a copy of the tracking number from (FedEx, United

States Postal Services (USPS), and United Parcel Services (UPS)) and/or a copy

of the QIC notification of receipt date for the reconsideration request.