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Frequently Asked Questions


What are the different types of letters that my facility will receive related to improper payments?

The letters the Recovery Auditor (RA) issues varies by whether an improper payment has been identified by automated or complex review. For automated reviews, providers will receive an informational letter beginning 1/3/12. For complex reviews, providers will receive a medical record request letter and a review results letter. In the event that the review results letter contains a notification of improper payment, a demand letter will then be issued by the Medicare Administrative Contractor (MAC).


What do I do when I receive a demand letter?

You first review the demand letter and Medicare regulation to understand the improper payment determination. To avoid any interest assessment, you should refund the monies within 30 days from the date of the demand letter; you have the option of issuing a check or requesting immediate offset by the Medicare Claims Processing Contractor. You may also have the amount recouped by taking no action after the receipt of the demand letter. If you choose recoupment, interest will be assessed after the 30th day. If you have additional information or disagree with the demand letter there are options available to you. You may file a Discussion (with the RA) by following the directions on your demand letter; or, you may file an appeal (with the Medicare Claims Processing Contractor), which if done within 30 days, stops recoupment. We strongly urge providers to submit any documentation or information relating to a Discussion with the RA as soon as possible after receipt of a informational or review results letter.


Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will the MAC be sending out the demand letter on both the automated and complex RA reviews?

Yes. The MAC will be issuing the demand letters for all types of RA reviews


Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who will issue the Underpayment Notification Letter?

The RAs will continue to issue the Underpayment Notification Letters.


Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Will I receive any notification of an improper finding from the RA?

Yes. The RA will continue to send Review Results letters on complex reviews and Informational Letters on automated and semi-automated reviews. The Informational Letters will supply the majority of the audit detail previously supplied with the demand letter on automated and semi-automated reviews. The Review Results and Informational Letter will be sent to the designated address listed on the HDI Provider Portal.


Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I believe I should have received a demand letter but have not received it yet (after 1/3/2012)?

You would contact the Customer Service area at your MAC.


Providers have received notification that the Medicare Administrative Contractors (MACs) will begin issuing the demand letter on the Recovery Auditor (RA) improper payment findings. Who do I contact if I have a question or concern on a RA improper payment?

You would contact your RA. For Region D (HDI) you would contact the appropriate Provider Service number: Part A 866-590-5598 Part B 866-376-2319

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