US · guidance
CMS Pub. 100-08, ch. 9, § 9.5
Adjusting the Claim
The MAC shall process RAC-initiated overpayments the same as any overpayment
determined by the MAC.
The RAC shall submit claim adjustments directly to the Virtual Data Centers (VDCs) via
the file-based mass adjustment process. Manual adjustments shall be limited to those that
cannot be accommodated through more automated means. The MAC shall identify the
origin of any manual adjustments by assigning RAC adjustment reasons and/or discovery
codes as appropriate.
The MAC shall create an accounts receivable in accordance with the guidelines in the
Medicare Financial Management Manual (MFMM), Publication 100-06, Chapter 4,
Sections 20 and 80. The MAC shall issue all demand letters for any RAC identified
overpayment, following the same process as for any other payment recoupment. The
MAC shall include the initiating RAC’s name and contact information in all demand
letters. The MAC shall be responsible for fielding any administrative concerns related to
the claim adjustment, such as, the issuance of demand letters, timeframes for recoupment
and the appeals process. The RAC shall be responsible for any audit specific
communications, such as reviewer rationale inquiries and discussion requests.
History
(Rev. 921, Issued: 11-06-19 Effective: 11-04- 19, Implementation: 11-04-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
21c61643d3f5984c878483fc0c680cdd49c3bad0ad3b3fbb05d9aaac57553e0e
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