Articles Tagged with medicare appeal

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When Medicare conducts an audit of a provider and concludes that an overpayment has occurred it will attempt to recoup that overpayment.  This article will discuss the overpayment appeals process.

There are five levels of appeal, each of which is considered a completely new examination of the audit and determination.  Unlike a judicial appeal in which the appellate court often reviews the lower court only for plain error or an abuse of discretion, these Medicare appeals are independent determinations and not tied to the prior overpayment determination.

After an initial finding of an overpayment, the first level of review is called a redetermination. A redetermination is performed by an independent Medicare Administrative Contractor (MAC). Redeterminations must be filed within 120 days of the initial determination.  Redetermination decisions should be issued within 60 days.