US · guidance
CMS Pub. 100-16, ch. mc86c17f, § 40.5
Recoupment
(Rev. 77, Issued: 10-28-05, Effective Date: 10-28-05)
(42 CFR 417.458) A Medicare cost plan agrees not to recoup deductible and coinsurance
amounts for which Medicare enrollees were liable in a previous contract period except in
the following circumstances:
• The Medicare cost plan failed to collect the deductible and coinsurance amounts
during the contract period in which they were due because of:
o Underestimation of the actuarial value of the deductible and coinsurance
amounts; or
o A billing error;
• The Medicare cost plan has identified the amounts and obtained advance CMS
approval of the recoupment and the method and timing of recoupment;
• The Medicare cost plan collects these amounts no later than the end of the
contract period following the contract period during which they were found to be
due.
History
(Rev. 77, Issued: 10-28-05, Effective Date: 10-28-05)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ef7b5a1633ebf5bf236dc75079e5b694fd9202ceabb416b2ca0478748fffa1e2
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