Responsibility for demand letters to shift to Medicare contractors

Tuesday, August 16, 2011

BALTIMORE - Starting in Jan. 3, 2012, Medicare's Recovery Auditors will longer issue demand letters, according to a recent MLN Matters article from CMS.

Instead, when the Recovery Auditor finds improper payments, it will submit claims adjustments to the provider's Medicare claims processing contractor. The contractor will then send demand letters for any overpayment. The contractor will follow the same process it uses to recover any other overpayments from a provider.

The processing contractor will be responsible for fielding questions and concerns from providers, such as timeframes for payment recovery and the appeals process.

The demand letter will include the name and contact information of the initiating Recovery Auditor, and the provider should contact that auditor for audit-specific questions.

To see the official instruction (CR7436) issued to your Medicare contractor, see on the CMS website.