US · guidance
CMS Pub. 100-08, ch. 8, § 8.2.3.3.4
Option 1 - Election to Proceed to Statistical Sampling for
Overpayment Estimation
(Rev. 10228; Issued: 07-27-20; Effective: 08-27-20; Implementation: 08-27-20)
If a provider or supplier fails to respond, this option shall be selected by default. For
providers or suppliers who select this option knowingly or by default, thereby rejecting
the consent settlement offer and retaining their full appeal rights, UPICs and the
contractor medical review units shall:
• Notify the provider or supplier of the actual overpayment and refer to overpayment
recoupment staff; and
• Initiate statistical sampling for overpayment estimation of the provider's or supplier’s
claims for the service under review following instructions in the Program Integrity
Manual, chapter 8, §8.4
If the review results in a decision to recoup the overpayment, the overpayment collection
shall be initiated within 12 months of the decision.
History
(Rev. 10228; Issued: 07-27-20; Effective: 08-27-20; Implementation: 08-27-20)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
618471876ee270e8506a2098f4e6c72b85c76d80146650b06afe5df4b52c99da
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