Overpayment / Underpayment and Appeals Process

Process for Sending Overpayments/Underpayments to the Medicare Administrative Contractor (MAC)

The SMRC waits a minimum of 60 days from the final review results letter and 30 days after the re-review results letter before referring denied claims to the MAC for recoupment.

When the SMRC audit finalizes, the SMRC compiles all claims with an identified overpayment/underpayment and sends them to the MAC for processing. Once received, the MACs will adjust the referred claims and issue overpayment demand letters. Demand letters issued by the MAC include applicable appeal rights.

Providers and suppliers are encouraged to watch for demand letters and remittance advice notices from their MACs for claims reviewed by the SMRC. Questions related to overpayments and their processing should be directed to the MAC.

Appeals Process

When the provider/supplier receives a demand letter from the MAC, options are available to appeal with the MAC. The demand letter contains information on how to exercise your appeal rights.

First Level of Appeal Redetermination

  • Provider/supplier has 120 days from the MAC demand letter date to file an appeal
  • The MAC completes the redetermination within 60 days from receipt of the appeal
  • Collection stops during appeals process
  • Any future appeal rights will be included in the redetermination results letters from the MAC

Last Updated Mar 22, 2024