Recovery Audit Contractor Provider Options Table

What should you do if you disagree with your RAC overpayment determination? The below chart breaks down the different options providers have when disputing a RAC overpayment determination.

Provider Options – RAC Overpayment Determination

Discussion	Period	Rebuttal	Redetermination
Which option should I use?	The discussion period offers the opportunity for the provider to provide additional information to the RAC to indicate why recoupment should not be initiated. It also offers the opportunity for the RAC to explain the rationale for the overpayment decision.	A rebuttal should be submitted only on rare occasions of extreme financial hardship. The rebuttal process allows the provider the opportunity to provide a statement and accompanying evidence indicating why the overpayment action will cause an extreme financial hardship and should not take place. A rebuttal is not intended to review supporting medical documentation nor disagreement with the overpayment decision. A rebuttal should not duplicate the redetermination process	A redetermination is the first level of appeal. A provider may request a redetermination when they are dissatisfied with the overpayment decision. A redetermination must be submitted within 30 days to prevent offset on day 41.
Who do I contact?	Recovery Audit Contractor (RAC)	Contractor/MAC	Contractor/MAC
Timeframe	Day 1 – 40	Day 1-15	Day 1-120 Must be submitted within 120 days of receipt of demand letter. To prevent offset on day 41 the Redetermination must be filed within 30 days.
Timeframe Begins	Automated Review: Upon receipt of Demand Letter Complex Review: Upon receipt of Review Results Letter	Date of Demand Letter	Upon receipt of Demand Letter
Timeframe Ends	Day 40 (offset begins on day 41)	Day 15	Day 120

Source: https://www.noridianmedicare.com